Human methionine synthase reductase: cloning, and methods for evaluating risk of neural tube deffects, cardiovascular disease, cancer and Down&#39;s Syndrome

ABSTRACT

The invention features a novel gene encoding methionine synthase reductase. The invention also features a method for detecting an increased likelihood of hyperhomocysteinemia and, in turn, an increased or decreased likelihood of neural tube defects, cardiovascular disease, Down&#39;s Syndrome or cancer. The invention also features therapeutic methods for treating and/or reducing the risk of cardiovascular disease, Down&#39;s Syndrome, cancer, or neural tube defects. Also provided are the sequences of the human methionine synthase reductase gene and protein and compounds and kits for performing the methods of the invention.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. Ser. No. 09/487,841, filedJan. 19, 2000, which claims priority from U.S. Ser. No. 09/371,347,filed Aug. 10, 1999, which claims priority from U.S. Ser. No.09/232,028, filed on Jan. 15, 1999, which claims priority from U.S.Provisional Application No. 60/071,622, filed Jan. 16, 1998.

FIELD OF THE INVENTION

This invention relates to the diagnosis and treatment of patients atrisk for disorders associated with altered methionine synthase activity.

BACKGROUND OF THE INVENTION

Methionine is an essential amino acid in mammals that is required forprotein synthesis. Methionine also plays a central role in metabolicreactions involving transfer of single-carbon moieties: in its activatedform, S-adenosylmethionine, methionine is the methyl donor in hundredsof biological transmethylation reactions. Moreover, methionine is thepropylamine donor in polyamine synthesis. The ultimate product resultingfrom the demethylation of methionine is homocysteine, the remethylationof which is catalyzed by a cobalamin-dependent enzyme, methioninesynthase (5-methyltetrahydrofolate:homocysteine methyltransferase, EC2.1.1.13).

The enzyme-bound cobalamin cofactor of methionine synthase plays anessential role in the methyl transfer reaction by acting as anintermediate methyl carrier between methyltetrahydrofolate andhomocysteine. The upper portion of FIG. 1 illustrates the transfer ofthe methyl group of methyltetrahydrofolate (CH₃-THF) to homocysteine viamethionine synthase-methylcobalamin [MetSyn-CH₃—Co(III)] as anintermediate methyl carrier. Cleavage of the methyl-cobalt bond of themethylcob(III)alamin intermediate occurs heterolytically so as to leavethe cobalamin in the highly reactive cob(I)alamin oxidation state. Theoccasional oxidation of the enzyme-cobalamin to the cob(II)alamin state[MetSyn-Co(II)] renders the enzyme inactive.

Severe deficiency of methionine synthase activity leads to megaloblasticanemia, developmental delay, hyperhomocysteinemia, andhypomethioninemia. Moreover, elevated plasma homocysteine is a riskfactor in cardiovascular disease and neural tube defects (Rozen, Clin.Invest. Med. 19:171-178, 1996).

Two forms of methionine synthase deficiency are known (Watkins et al.,Am. J. Med. Genet. 34:427-434, 1989; Gulati et al., J. Biol. Chem.272:19171-19175, 1997). The first is a primary defect of the amino acidsequence of the methionine synthase enzyme. We recently cloned cDNAsencoding human methionine synthase and showed that patients from thecblG complementation group of folate/cobalamin metabolism have mutationsin the methionine synthase gene. A second class of patients, belongingto a distinct complementation group, cblE, is also deficient inmethionine synthase enzymatic activity. The genetic basis of thisdeficiency has not been determined.

An analogous methylcobalamin-dependent methionine synthase has been wellcharacterized in E. coli and the structures comprising its C-terminalhalf have been elucidated by X-ray crystallography. The reductiveactivation system required for its maintenance is a two-componentflavoprotein system consisting of flavodoxin (a small FMN-containingelectron transfer protein), and NADPH-ferredoxin (flavodoxin)oxidoreductase, a member of a family of electron transferases termed the“FNR family.” However, flavodoxins are not found in mammalian cells.

It would be desirable to identify the enzyme that catalyzes thereductive activation of methionine synthase, i.e., the methioninesynthase reductase. Knowledge of the reductase wild-type nucleotide andamino acid sequences would allow the identification of mutations andpolymorphisms associated with diseases involving methionine metabolism.Moreover, an understanding of the reductase structure and function willfacilitate the identification of compounds that modulate its activity.Such compounds will be useful in treating and preventing disease anddevelopmental defects.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a diagram showing the enzymatic reaction that is catalyzed bymethionine synthase, and the reductive reactivation of methioninesynthase.

FIG. 2 is a diagram showing the overlapping clones and PCR fragmentsused to clone and sequence human methionine synthase reductase.

FIG. 3 is a diagram showing the nucleotide and deduced amino acidsequence of human methionine synthase reductase.

FIG. 4 is a diagram showing an amino acid sequence comparison amonghuman methionine synthase reductase (HsMTRR; SEQ ID NO: 21), C. elegansputative methionine synthase reductase (CeMTRR; SEQ ID NO: 22) and humancytochrome P450 reductase (HsCPR; SEQ ID NO: 23).

FIGS. 5A and 5B are representations of Northern blots showing ananalysis of methionine synthase reductase expression in human tissues.

FIG. 6 is a diagram summarizing the FISH mapping of the methioninesynthase reductase gene to human chromosome 5p15.2-p15.3.

FIGS. 7A and 7B are representations of gels showing a mutation analysisof cblE patient cell lines.

FIG. 7C is a diagram showing a sequence comparison of the NADPH bindingregion of FNR family members (SEQ ID NOs: 25-40) FIG. 8A is arepresentation of two autoradiograms showing the A to G polymorphism atMTRR coding position 66.

FIG. 8B is a representation of a gel showing a restriction digest assayfor distinguishing between the adenine 66 and guanine 66 alleles.

SUMMARY OF THE INVENTION

We have cloned the gene encoding human methionine synthase reductase.This enzyme maintains methionine synthase in its reduced, activatedstate, and hence is an essential component of the methionine syntheticpathway. Deficiency of methionine synthase reductase results inhyperhomocysteinemia, a condition that has been implicated incardiovascular disease and neural tube defects. The presence ofmutations in the methionine synthase reductase gene that decreasemethionine synthase reductase enzymatic activity are likely to beassociated with altered risk for cardiovascular disease, neural tubedefects, and cancer. The invention features methods for risk detectionand treatment of patients with hyperhomocysteinemia, cardiovasculardisease, neural tube defects, and cancer. The invention also featurescompounds and kits which may be used to practice the methods of theinvention, methods and compounds for treating or preventing theseconditions and methods of identifying therapeutics for the treatment orprevention of these conditions.

In a first aspect, the invention features substantially pure nucleicacid encoding a mammalian methionine synthase reductase polypeptide. Invarious embodiments, the nucleic acid may encode a human polypeptide,and the nucleic acid may be DNA, particularly genomic DNA or cDNA. Inanother embodiment, the nucleic acid has the sequence of SEQ ID NO: 1 orSEQ ID NO: 41, or degenerate variants thereof, and the nucleic acidencodes the amino acid sequence of SEQ ID NO: 2 or SEQ ID NO: 42. In yetanother embodiment, the nucleic acid is operably linked to regulatorysequences for expression of methionine synthase reductase. Theregulatory sequences comprise a promoter, and the promoter may beinducible.

In a second, related aspect, the invention features a substantially purenucleic acid that hybridizes at high stringency to the nucleic acid ofSEQ ID NO: 1 or SEQ ID NO: 41. In a preferred embodiment, the nucleicacid is a naturally occurring variant of the mammalian methioninesynthase reductase gene. In another embodiment, the nucleic acid has asequence complementary to at least 50% of at least 60 nucleotides of thenucleic acid encoding the methionine synthase reductase polypeptide, andthe sequence is sufficient to allow nucleic acid hybridization underhigh stringency conditions. In further embodiments, the nucleic acid maybe a probe or an antisense nucleic acid, and the sequence may becomplementary to at least 90% of at least 18 nucleotides of the nucleicacid encoding the methionine synthase reductase polypeptide.

In a third aspect, the invention features a nucleic acid encoding amutant or polymorphic mammalian methionine synthase reductasepolypeptide. In one embodiment, the nucleic acid may be from a human. Inanother embodiment, the mutation is a deletion mutation, for example, adeletion of 4 bases starting from base 1675 (bases 1675-1678) of SEQ IDNO:1 (SEQ ID NO: 47), or a deletion of 3 bases starting from base 1726(bases 1726-1728) of SEQ ID NO:1 (SEQ ID NO: 45). In still anotherembodiment the polymorphism is a nucleotide transition from G to A atnucleotide position 66 (SEQ ID NO: 41), or from G to A at nucleotideposition 110 (SEQ ID NO: 43). Other naturally-occurring variantsassociated with altered risk for hyperhomocysteinemia are also a featureof this aspect of the invention.

In a fourth, related aspect, the invention features a cell containingthe nucleic acid of the third aspect of the invention. In variousembodiments, the cell may be a prokaryotic cell, a eukaryotic cell, ayeast cell, or a mammalian cell.

In a fifth, related aspect, the invention features a non-humantransgenic animal containing the nucleic acid of the third aspect of theinvention. In one embodiment, the nucleic acid contains a mutationassociated with hyperhomocysteinemia.

In a sixth, related aspect, the invention features a non-human animalwherein one or both genetic alleles encoding a methionine synthasereductase polypeptide are mutated. In one embodiment of this sixthaspect, one or both genetic alleles encoding a methionine synthasereductase polypeptide are disrupted, deleted, or otherwise renderednonfunctional. In further embodiments of the fifth and sixth aspects,the animal may be a rodent (e.g., a mouse), or a nematode (e.g., C.elegans).

In a seventh, related aspect, the invention features a cell from theanimal of the fifth and sixth aspects.

In an eighth aspect, the invention features a substantially puremammalian methionine synthase reductase polypeptide. In variousembodiments, the polypeptide may be recombinant, or may be a humanpolypeptide, or may be the polypeptide set forth in SEQ ID NO: 2 or SEQID NO: 42.

In a ninth, related aspect, the invention features a polypeptide havingconservative amino acid substitutions relative to SEQ ID NO: 2 or SEQ IDNO: 42, and having methionine synthase reductase biological activity.

In a tenth, related aspect, the invention features a mutant orpolymorphic polypeptide which has less methionine synthase reductasebiological activity than the polypeptide of SEQ ID NO: 2. In preferredembodiments, the polypeptide has a frameshift resulting in a prematurestop codon (e.g., SEQ ID NO: 48), or a deletion mutation, such as adeletion of Leu576 (SEQ ID NO: 46). In other preferred embodiments, thepolypeptide may have an amino acid substitution, such as isoleucineinstead of methionine at amino acid position 22 (SEQ ID NO: 42), ortyrosine instead of cysteine at amino acid position 37 (SEQ ID NO: 44).

In an eleventh, related aspect, the invention features a mutant orpolymorphic polypeptide which has higher methionine synthase reductasebiological activity than the polypeptide set forth in SEQ ID NO: 2.

In a twelfth aspect, the invention features an antibody thatspecifically binds a methionine synthase reductase polypeptide. In oneembodiment, the polypeptide is a mutant or polymorphic polypeptide.

In a thirteenth, related aspect, the invention features a method ofgenerating an antibody that specifically binds a methionine synthasereductase polypeptide. The method comprises administering a methioninesynthase reductase polypeptide, or fragment thereof, to an animalcapable of generating an immune response, and isolating the antibodyfrom the animal. Preferred antibodies specifically bind mutantmethionine synthase reductase polypeptides.

In a fourteenth, related aspect, the invention features a method ofdetecting the presence of a methionine synthase reductase polypeptide.The method comprises contacting a sample with the antibody thatspecifically binds a methionine synthase reductase polypeptide andassaying for binding of the antibody to the polypeptide.

In a fifteenth aspect, the invention features a method for detectingsequence variants for methionine synthase reductase in a mammal. Themethod comprises analyzing the nucleic acid of a test subject todetermine whether the test subject contains a mutation or polymorphismin a methionine synthase reductase gene. The presence of the mutation orpolymorphism is an indication that the animal has an increased ordecreased likelihood of developing hyperhomocysteinemia, cardiovasculardisease, neural tube defects, or cancer.

In one embodiment of the fifteenth aspect, primers used for detecting amutation are selected from: 5′-CTCCTGCTCGAACATCTTCCTAAA (SEQ ID NO: 3);5′-AATAGATAAT CCCTATCCTTATGCC (SEQ ID NO: 4); 5′-CCCTGGCTCCTAAGATATCCATC(SEQ ID NO: 5); 5′-CGAACAACAAA TTCTTTCCACTTACC (SEQ ID NO: 6);5′-CAAGGTTGGTGGAA GTCGCGTTG (SEQ ID NO: 7); 5′-ATGCCTTGAAGTGATGAGGAGGTTT (SEQ ID NO: 8); 5′-TTCCTACAACATAGAGAGAAACTC (SEQ ID NO: 9);5′-TTGCACAAGGGCATCATGTACATC (SEQ ID NO: 10); 5′-AAACCTCCTCATCACTTCAAGGCAT (SEQ ID NO: 11); 5′-CTTGCACACGAATATG GTCTGGG (SEQ IDNO: 12); 5′-TGGCATCACCTGCATCCTTGAGG (SEQ ID NO: 13);5′-GATGTACCTGTAAATATTCTGGGGG (SEQ ID NO: 14); 5′-AATCCACGGCTCAACCACAAGTTC (SEQ ID NO: 15); 5′-CTCGAAATT AACCCTCACTAAAGGG (SEQ ID NO:16); 5′-AACCCATACCGCAG GTGAGCAAA (SEQ ID NO: 17);5′-TTTAGTACTTTCAGTCAAAAAA GCTTAAT (SEQ ID NO: 18); 5′-ATAAACGACTTCAAGAGCTTGGAGC (SEQ ID NO: 19); or 5′-AGGTTTGGCACTAGTAAAGCTGACT (SEQ ID NO:20).

In another embodiment of the fifteenth aspect of the invention, themethod further comprises the step of using nucleic acid primers specificfor the methionine synthase reductase gene. The primers are used for DNAamplification by the polymerase chain reaction. In yet anotherembodiment, the step further comprises the step of sequencing nucleicacid encoding methionine synthase reductase from the test subject. Instill other embodiments, the analyzing includes single strandconformational polymorphism (SSCP) analysis, or the method is carriedout by restriction fragment length (RFLP) polymorphism analysis. Infurther embodiments, the method is for the diagnosis of an altered riskfor cardiovascular disease, neural tube defects, or cancer, such ascolon cancer.

In a sixteenth aspect, the invention features a kit for the analysis ofmammalian methionine synthase reductase nucleic acid. The kit comprisesnucleic acid probes for analyzing the nucleic acid of a mammal, and theanalyzing is sufficient to determine whether the mammal contains amutation in the methionine synthase reductase nucleic acid. In apreferred embodiment the nucleic acid probes allow detection ofmutations associated with hyperhomocysteinemia.

In a seventeenth aspect, the invention features a kit for the analysisof mammalian methionine synthase reductase polypeptides. The kitcomprises antibodies for analyzing the methionine synthase reductasepolypeptide of a mammal, and the analyzing is sufficient to determinewhether the mammal contains a mutation in the methionine synthasereductase nucleic acid.

In an eighteenth aspect, the invention features a method of treating orpreventing cancer, cardiovascular disease, or neural tube defects. Themethod comprises inhibiting methionine synthase reductase biologicalactivity. In one embodiment, the mammal is pregnant. In otherembodiments, the method comprises administering a therapeuticallyeffective dose of a methionine synthase reductase inhibitor to a mammal.The inhibitor may be a methionine synthase reductase anti-sense nucleicacid, a peptide comprising a portion of a mammalian methionine synthasereductase polypeptide, or a small molecule.

In a nineteenth aspect, the invention features a method of treating orpreventing cardiovascular disease. The method comprises administering tothe subject a therapeutically effective dose of a metabolite or cofactorselected from the group: folate, cobalamin, S-adenosyl methionine,betaine, or methionine.

In a twentieth aspect, the invention features a method of preventingneural tube defects, cancer, or cardiovascular disease. The methodcomprises: a) detecting an increased risk of neural tube defects,cancer, or cardiovascular disease, wherein the detecting is performed byanalyzing methionine synthase reductase nucleic acid from one or moretest subjects selected from: a mammal; a potential parent, either maleor female; a pregnant mammal; or a developing embryo or fetus, whereinthe analyzing is done by the method of the fifteenth aspect of theinvention; and b) exposing the mammal, potential parent, pregnantmammal, and/or developing embryo or fetus to a therapeutically effectivedose of a metabolite or cofactor selected from the group: cobalamin;S-adenosyl methionine; betaine; or methionine, wherein the exposing isvia the administration of the dose to the mammal, the potential parent,the pregnant mammal, and/or the developing embryo or fetus.

In a preferred embodiment of the eighteenth and twentieth aspects of theinvention, the subject has been diagnosed as having a mutation orpolymorphism in methionine synthase reductase.

In a twenty-first aspect, the invention features a method of screeningfor a compound that modulates methionine synthase reductase biologicalactivity. The method comprises the steps of: a) contacting a samplecontaining wild-type, mutated, or polymorphic methionine synthasereductase with the compound, and b) assaying for methionine synthasereductase enzymatic activity, wherein increased enzymatic activityindicates an inducer of methionine synthase reductase biologicalactivity, and decreased enzymatic activity indicates an inhibitor ofmethionine synthase reductase biological activity.

In a twenty-second aspect, the invention features a method for screeningfor a compound that modulates methionine synthase reductase biologicalactivity. The method comprises the steps of: a) contacting a sample withthe compound, and b) assaying for methionine synthase reductaseexpression, wherein increased expression indicates an inducer ofmethionine synthase reductase biological activity, and decreasedexpression indicates an inhibitor of methionine synthase reductasebiological activity. The sample is selected from: purified or partiallypurified methionine synthase reductase, a cell lysate, a cell, anematode, or a mammal. In preferred embodiments, the sample may be theanimal or cell described by the fifth and sixth aspects of theinvention. In other preferred embodiments, the screening may be forcompounds useful for the treatment or prevention of cardiovasculardisease or cancer, or for the prevention of neural tube defects.

In a twenty-third aspect, the invention features a method for detectingan increased risk of developing a neural tube defect in a mammalianembryo or fetus. The method includes detecting the presence of apolymorphic methionine synthase reductase (MTRR) in a test subject,wherein the polymorphic MTRR contains a methionine instead of anisoleucine at amino acid position 22, wherein the test subject is afuture parent of the embryo or fetus, and wherein detection of ahomozygous MTRR polymorphism in the future parent, embryo, or fetus, ordetection of either a homozygous or heterozygous MTRR polymorphism inboth future parents, indicates an increased risk of developing a neuraltube defect in the embryo or fetus.

In various embodiments of the twenty-third aspect of the invention, thepolymorphic MTRR may be detected by analyzing nucleic acid from the testsubject. The nucleic acid may be genomic DNA or cDNA. The nucleic acidmay contain a G instead of an A at the third position of thetwenty-second codon (nucleotide position 66, relative to the firstnucleotide of the start codon) of MTRR.

In another embodiment of the twenty-third aspect of the invention, themethod may further include: a) PCR-amplifying a segment of MTRR nucleicacid using primers MSG108S (SEQ ID NO: 49) and AD292 (SEQ ID NO: 50),and b) digesting the product of the PCR amplification reaction with therestriction enzyme Nde I, wherein a PCR product that is digested by NdeI indicates an increased risk of developing a neural tube defect in amammalian embryo or fetus.

In still other embodiments of the twenty-third aspect of the invention,the polymorphic MTRR may be detected by analyzing MTRR polypeptide fromthe test subject, and the test subject may be a future female parent ofthe embryo or fetus, or the test subject may be the embryo or fetusitself.

In yet further embodiments of the twenty-third aspect of the invention,the method may further include detecting the presence of a polymorphicmethylenetetrahydrofolate reductase (MTHFR) in a test subject, thepolymorphic MTHFR having a T instead of a C at a nucleotide positionequivalent to position 677 of SEQ ID NO: 51, wherein detection of thepolymorphic MTHFR indicates an increased risk of developing a neuraltube defect in the embryo or fetus. The polymorphic MTHFR may bedetected by analyzing nucleic acid or polypeptide from the test subject.

In still another embodiment of the twenty-third aspect of the invention,the method may further include measuring the level of cobalamin in thetest subject, wherein a low cobalamin level indicates an increased riskof developing a neural tube defect in the embryo or fetus.

In a twenty-fourth aspect of the present invention, the inventionfeatures a method for detecting an increased risk of developing Down'sSyndrome in a mammal, preferably a mammalian embryo or fetus. In atwenty-fifth aspect the invention features a method for detecting anincreased risk of developing premature coronary artery disease. Bothaspects include detecting the presence of a polymorphic MTRR in a testsubject. Preferably, the polymorphic MTRR contains a common A→Gpolymorphism at position 66 of the MTRR cDNA sequence (SEQ ID NO: 1),wherein the test subject is a mammal, preferably a future parent of anembryo or fetus or an embryo or a fetus, and wherein detection of ahomozygous MTRR polymorphism indicates an increased risk of developing aDown's Syndrome or coronary artery disease defect in the embryo orfetus.

In various embodiments of the twenty-fourth aspect of the invention, thepolymorphic MTRR may be detected by analyzing nucleic acid from the testsubject. The nucleic acid may be genomic DNA or cDNA. The nucleic acidmay contain a G instead of an A at the third position of thetwenty-second codon (nucleotide position 66, relative to the firstnucleotide of the start codon) of MTRR.

In another embodiment of the twenty-fourth or twenty-fifth aspects ofthe invention, the method may further include: a) PCR-amplifying asegment of MTRR nucleic acid using primers MSG108S (SEQ ID NO: 49) andAD292 (SEQ ID NO: 50) or A (SEQ ID NO:61) and B (SEQ ID NO:62), and b)digesting the product of the PCR amplification reaction with therestriction enzyme Nde I, wherein a PCR product that is digested by NdeI indicates an increased risk of developing a neural tube defect in amammalian embryo or fetus.

In still other embodiments of the twenty-fourth or twenty-fifth aspectsof the invention, the polymorphic MTRR may be detected by analyzing MTRRpolypeptide from the test subject, and the test subject may be a futurefemale parent of the embryo or fetus, or the test subject may be theembryo or fetus itself.

In further aspects of the invention, the invention features a method fordetecting the presence of a polymorphic methylenetetrahydrofolatereductase (MTHFR) in a test subject, (preferably an MTHFR having a Tinstead of a C at a nucleotide position equivalent to position 677 ofSEQ ID NO: 51), wherein detection of the polymorphic MTHFR indicates anincreased risk of developing Down's Syndrome in the embryo or fetus. Thepolymorphic MTHFR may be detected by analyzing nucleic acid orpolypeptide from the test subject.

In still another embodiment of the twenty-fourth or twenty-fifth aspectsof the invention, the method may further include measuring the level ofcobalamin in the test subject, wherein a low cobalamin level indicatesan increased risk of developing Down's Syndrome or prematurecardiovascular disease in the embryo or fetus.

By “methionine synthase reductase,” “methionine synthase reductaseprotein,” or “methionine synthase reductase polypeptide” is meant apolypeptide, or fragment thereof, which has at least 43% amino acidsequence identity, or at least 53% sequence similarity, preferably atleast 47% identity (or at least 57% similarity), more preferably atleast 55% identity (or at least 65% similarity), yet more preferably atleast 65% sequence identity (or at least 75% similarity), still morepreferably at least 75% sequence identity (or at least 85% similarity)and most preferably at least 85% sequence identity (or at least 95%similarity) to the human methionine synthase reductase polypeptide ofSEQ ID NO: 2 (see FIG. 4), over the length of the polypeptide orfragment thereof, or over the length of the human methionine synthasereductase polypeptide of SEQ ID NO: 2, whichever is shorter in length.It is understood that polypeptide products from splice variants ofmethionine synthase reductase gene sequences are also included in thisdefinition. Preferably, the methionine synthase reductase protein isencoded by nucleic acid having a sequence which hybridizes to a nucleicacid sequence present in SEQ ID NO: 1 (human methionine synthasereductase cDNA) under stringent conditions. Even more preferably theencoded polypeptide also has methionine synthase reductase biologicalactivity, or is a mutant or polymorphic form of methionine synthasereductase that is associated with an increased risk of disease.

By “methionine synthase reductase nucleic acid” or “methionine synthasereductase gene” is meant a nucleic acid, such as genomic DNA, cDNA, ormRNA, that encodes methionine synthase reductase, a methionine synthasereductase protein, methionine synthase reductase polypeptide, or portionthereof, as defined above.

By “mutant methionine synthase reductase,” “methionine synthasereductase mutation(s),” “mutations in methionine synthase reductase,”“polymorphic methionine synthase reductase,” “methionine synthasereductase polymorphism(s),” “polymorphisms in methionine synthasereductase,” is meant a methionine synthase reductase (MTTR) polypeptideor nucleic acid having a sequence that confers an increased risk of adisease phenotype or enhanced protection against a disease in at leastsome genetic and/or environmental backgrounds. An example of adisease-associated methionine synthase reductase polymorphism is the 22Mpolymorphism (SEQ ID NO: 2), which is associated with an increased riskfor neural tube defects.

Any given methionine synthase reductase polymorphism may be associatedwith an increased risk for some diseases and a decreased risk for otherdieseases. Increased or decreased disease risks associated with specificmethionine synthase reductase mutations and polymorphisms are determinedby methods known to those skilled in the art.

Such mutations may be naturally occurring, or artificially induced. Theymay be, without limitation, transition, transversion, insertion,deletion, frameshift, or missense mutations. A mutant methioninesynthase reductase protein may have one or more mutations, and suchmutations may affect different aspects of methionine synthase reductasebiological activity (protein function), to various degrees.Alternatively, a methionine synthase reductase mutation may indirectlyaffect methionine synthase reductase biological activity by influencing,for example, the transcriptional activity of a gene encoding methioninesynthase reductase, or the stability of methionine synthase reductasemRNA. For example, a mutant methionine synthase reductase gene may be agene that expresses a mutant methionine synthase reductase protein ormay be a gene which alters the level of methionine synthase reductaseprotein in a manner sufficient to confer a disease phenotype in at leastsome genetic and/or environmental backgrounds. The presence ofpolymorphic or mutant methionine synthase reductase may be determined bydetecting polymorphic or mutant methionine synthase reductase nucleicacid or polypeptide, using methods that are known in the art.

By “biologically active” methionine synthase reductase is meant amethionine synthase reductase protein or methionine synthase reductasegene that provides at least one biological function equivalent to thatof the wild-type methionine synthase reductase polypeptide or themethionine synthase reductase gene. Biological activity of a methioninesynthase reductase polypeptide includes, but is not limited to, theability to catalyze the reductive methylation of enzymatically inactivemethionine synthase-cob(II)alamin to generate enzymatically activemethionine synthase-cob(III)alamin-CH3. Preferably, a biologicallyactive methionine synthase reductase will display activity equivalent toat least 20-30% of wild-type activity, more preferably, at least 35-50%of wild-type activity, still more preferably, 55-75% of wild-typeactivity, and most preferably, a biologically active methionine synthasereductase will display at least 80-90% of wild-type activity. Abiologically active methionine synthase reductase also may display morethan 100% of wild-type activity. Preferably, the biological activity ofthe wild-type methionine synthase reductase is determined using themethionine synthase reductase nucleic acid of SEQ ID NO: 1 or SEQ ID NO:41 or methionine synthase reductase polypeptide of SEQ ID NO: 2 or SEQID NO: 42. The degree of methionine synthase reductase biologicalactivity may be intrinsic to the methionine synthase reductasepolypeptide itself, or may be modulated by increasing or decreasing thenumber of methionine synthase reductase polypeptide molecules presentintracellularly.

By “high stringency conditions” is meant hybridization in 2×SSC at 40°C. with a DNA probe length of at least 40 nucleotides. For otherdefinitions of high stringency conditions, see Ausubel et al., CurrentProtocols in Molecular Biology, pp. 6.3.1-6.3.6, John Wiley & Sons, NewYork, N.Y., 1998, hereby incorporated by reference.

By “analyzing” or “analysis” is meant subjecting a methionine synthasereductase nucleic acid or methionine synthase reductase polypeptide to atest procedure that allows the determination of whether a methioninesynthase reductase gene is wild-type or mutant. For example, one couldanalyze the methionine synthase reductase genes of an animal byamplifying genomic DNA using the polymerase chain reaction, and thendetermining the DNA sequence of the amplified DNA.

By “probe” or “primer” is meant a single-stranded DNA or RNA molecule ofdefined sequence that can base pair to a second DNA or RNA molecule thatcontains a complementary sequence (the “target”). The stability of theresulting hybrid depends upon the extent of the base pairing thatoccurs. The extent of base-pairing is affected by parameters such as thedegree of complementarity between the probe and target molecules, andthe degree of stringency of the hybridization conditions. The degree ofhybridization stringency is affected by parameters such as temperature,salt concentration, and the concentration of organic molecules such asformamide, and is determined by methods known to one skilled in the art.Probes or primers specific for methionine synthase reductase nucleicacid preferably will have at least 35% sequence identity, morepreferably at least 45-55% sequence identity, still more preferably atleast 60-75% sequence identity, still more preferably at least 80-90%sequence identity, and most preferably 100% sequence identity. Probesmay be detectably-labelled, either radioactively, or non-radioactively,by methods well-known to those skilled in the art. Probes are used formethods involving nucleic acid hybridization, such as: nucleic acidsequencing, nucleic acid amplification by the polymerase chain reaction,single stranded conformational polymorphism (SSCP) analysis, restrictionfragment polymorphism (RFLP) analysis, Southern hybridization, Northernhybridization, in situ hybridization, electrophoretic mobility shiftassay (EMSA).

By “pharmaceutically acceptable carrier” means a carrier which isphysiologically acceptable to the treated mammal while retaining thetherapeutic properties of the compound with which it is administered.One exemplary pharmaceutically acceptable carrier is physiologicalsaline. Other physiologically acceptable carriers and their formulationsare known to one skilled in the art and described, for example, inRemington's Pharmaceutical Sciences, (18^(th) edition), ed. A. Gennaro,1990, Mack Publishing Company, Easton, Pa.

By “substantially identical” is meant a polypeptide or nucleic acidexhibiting, over its entire length, at least 50%, preferably 85%, morepreferably 90%, and most preferably 95% identity to a reference aminoacid or nucleic acid sequence. For polypeptides, the length ofcomparison sequences will generally be at least 16 amino acids,preferably at least 20 amino acids, more preferably at least 25 aminoacids, and most preferably 35 amino acids. For nucleic acids, the lengthof comparison sequences will generally be at least 50 nucleotides,preferably at least 60 nucleotides, more preferably at least 75nucleotides, and most preferably 110 nucleotides.

By “identity” is meant that a polypeptide or nucleic acid sequencepossesses the same amino acid or nucleotide residue at a given position,compared to a reference polypeptide or nucleic acid sequence to whichthe first sequence is aligned.

Sequence identity is typically measured using sequence analysis softwarewith the default parameters specified therein (e.g., Sequence AnalysisSoftware Package of the Genetics Computer Group, University of WisconsinBiotechnology Center, 1710 University Avenue, Madison, Wis. 53705). Thissoftware program matches similar sequences by assigning degrees ofhomology to various substitutions, deletions, and other modifications.Conservative substitutions typically include substitutions within thefollowing groups: glycine, alanine, valine, isoleucine, leucine;aspartic acid, glutamic acid; asparagine, glutamine; serine, threonine;lysine, arginine; and phenylalanine, tyrosine.

By “substantially pure polypeptide” is meant a polypeptide that has beenseparated from the components that naturally accompany it. Typically,the polypeptide is substantially pure when it is at least 60%, byweight, free from the proteins and naturally-occurring organic moleculeswith which it is naturally associated. Preferably, the polypeptide is amethionine synthase reductase polypeptide that is at least 75%, morepreferably at least 90%, and most preferably at least 99%, by weight,pure. A substantially pure methionine synthase reductase polypeptide maybe obtained, for example, by extraction from a natural source (e.g., afibroblast) by expression of a recombinant nucleic acid encoding amethionine synthase reductase polypeptide, or by chemically synthesizingthe protein. Purity can be measured by any appropriate method, e.g., bycolumn chromatography, polyacrylamide gel electrophoresis, or HPLCanalysis.

A protein is substantially free of naturally associated components whenit is separated from those contaminants which accompany it in itsnatural state. Thus, a protein which is chemically synthesized orproduced in a cellular system different from the cell from which itnaturally originates will be substantially free from its naturallyassociated components. Accordingly, substantially pure polypeptides notonly includes those derived from eukaryotic organisms but also thosesynthesized in E. coli or other prokaryotes.

By “substantially pure DNA” is meant DNA that is free of the geneswhich, in the naturally-occurring genome of the organism from which theDNA of the invention is derived, flank the gene. The term thereforeincludes, for example, a recombinant DNA which is incorporated into avector; into an autonomously replicating plasmid or virus; or into thegenomic DNA of a prokaryote or eukaryote; or which exists as a separatemolecule (e.g., a cDNA or a genomic or cDNA fragment produced by PCR orrestriction endonuclease digestion) independent of other sequences. Italso includes a recombinant DNA which is part of a hybrid gene encodingadditional polypeptide sequence.

By “transgene” is meant any piece of DNA that is inserted by artificeinto a cell, and becomes part of the genome of the organism thatdevelops from that cell. Preferably the coding region of the transgeneis operably linked to one or more transcriptional regulatory elements,including a promoter (as defined below) that direct transgeneexpression. Such a transgene may comprise a gene which is partly orentirely heterologous (i.e., foreign) to the transgenic organism, or mayrepresent a gene homologous to an endogenous gene of the organism.

By “transgenic” is meant any cell that includes a DNA sequence that isinserted by artifice into a cell and becomes part of the genome of theorganism which develops from that cell. As used herein, the transgenicorganisms are generally transgenic mammals (e.g., rodents such as ratsor mice) and the DNA (transgene) is inserted by artifice into thegenome. Transgenic organisms also may include transgenic nematodes, suchas transgenic Caenorrhabditis elegans, which are generated by methodsknown to those skilled in the art.

By “knockout mutation” is meant an alteration in the nucleic acidsequence that reduces the biological activity of the polypeptidenormally encoded therefrom by at least 80% relative to the unmutatedgene. The mutation may, without limitation, be an insertion, deletion,frameshift mutation, or a missense mutation. Preferably, the mutation isan insertion or deletion, or is a frameshift mutation that creates astop codon.

By “transformation” is meant any method for introducing foreignmolecules into a cell (e.g., a bacterial, yeast, fungal, algal, plant,insect, or animal cell). Lipofection, DEAE-dextran-mediatedtransfection, microinjection, protoplast fusion, calcium phosphateprecipitation, retroviral delivery, electroporation, and biolistictransformation are just a few of the methods known to those skilled inthe art which may be used.

By “transformed cell” is meant a cell (or a descendant of a cell) intowhich a DNA molecule encoding a methionine synthase reductasepolypeptide has been introduced, by means of recombinant DNA techniques.

By “positioned for expression” is meant that the DNA molecule ispositioned adjacent to a DNA sequence which directs transcription andtranslation of the sequence (i.e., facilitates the production of, e.g.,a methionine synthase reductase polypeptide, a recombinant protein or aRNA molecule).

By “promoter” is meant a minimal sequence sufficient to directtranscription. Also included in the invention are those promoterelements which are sufficient to render promoter-dependent geneexpression controllable for cell type-specific, tissue-specific,temporal-specific, or inducible by external signals or agents; suchelements may be located in the 5′ or 3′ or intron sequence regions ofthe native gene.

By “operably linked” is meant that a gene and one or more regulatorysequences are connected in such a way as to permit gene expression whenthe appropriate molecules (e.g., transcriptional activator proteins) arebound to the regulatory sequences.

By “conserved region” is meant any stretch of six or more contiguousamino acids exhibiting at least 30%, preferably at least 50%, and mostpreferably at least 70% amino acid sequence identity between two or morereductase family members, (e.g., between human methionine synthasereductase and human cytochrome p450 reductase). An example of aconserved region within these two reductases is the NADPH binding region(FIG. 4).

By “detectably-labeled” is meant any means for marking and identifyingthe presence of a molecule, e.g., an oligonucleotide probe or primer, agene or fragment thereof, or a cDNA molecule. Methods fordetectably-labeling a molecule are well known in the art and include,without limitation, radioactive labeling (e.g., with an isotope such as³²P or ³⁵S) and nonradioactive labeling (e.g., chemiluminescent orfluorescent labeling, e.g., fluorescein labeling).

By “antisense” as used herein in reference to nucleic acids, is meant anucleic acid sequence that is complementary to the coding strand of agene, preferably, a methionine synthase reductase gene. An antisensenucleic acid is capable of preferentially decreasing the activity of amutant methionine synthase reductase polypeptide encoded by a mutantmethionine synthase reductase gene.

By “specifically binds” is meant that an antibody recognizes and binds ahuman methionine synthase reductase polypeptide, but does notsubstantially recognize and bind other non-methionine synthase reductasemolecules in a sample, e.g., a biological sample, that naturallyincludes protein. A preferred antibody binds to the methionine synthasereductase polypeptide sequence of SEQ ID NO: 2 (FIG. 3).

By “neutralizing antibodies” is meant antibodies that interfere with anyof the biological activities of a wild-type or mutant methioninesynthase reductase polypeptide, for example, the ability of methioninesynthase reductase to catalyze the transfer of a methyl group tomethionine synthase-cobal(II)amin. The neutralizing antibody may reducethe ability of a methionine synthase reductase polypeptide to catalyzethe transfer preferably by 10% or more, more preferably by 25% or more,still more preferably by 50% or more, yet preferably by 70% or more, andmost preferably by 90% or more. Any standard assay for the biologicalactivity of methionine synthase reductase may be used to assesspotentially neutralizing antibodies that are specific for methioninesynthase reductase.

By “expose” is meant to allow contact between an animal, cell, lysate orextract derived from a cell, or molecule derived from a cell, and a testcompound.

By “treat” is meant to submit or subject an animal (e.g. a human), cell,lysate or extract derived from a cell, or molecule derived from a cellto a test compound.

By “test compound” is meant a chemical, be it naturally-occurring orartificially-derived, that is surveyed for its ability to modulate analteration in reporter gene activity or protein levels, by employing oneof the assay methods described herein. Test compounds may include, forexample, peptides, polypeptides, synthesized organic molecules,naturally occurring organic molecules, nucleic acid molecules, andcomponents thereof.

By “assaying” is meant analyzing the effect of a treatment, be itchemical or physical, administered to whole animals, cells, or lysates,extracts, or molecules derived therefrom. The material being analyzedmay be an animal, a cell, a lysate or extract derived from a cell, or amolecule derived from a cell. The analysis may be for the purpose ofdetecting altered protein biological activity, altered proteinstability, altered protein levels, altered gene expression, or alteredRNA stability. The means for analyzing may include, for example, thedetection of the product of an enzymatic reaction, (e.g., the formationof active methionine synthase or methionine as a result of methioninesynthase reductase activity), antibody labeling, immunoprecipitation,and methods known to those skilled in the art for detecting nucleicacids.

By “modulating” is meant changing, either by decrease or increase, inbiological activity.

By “a decrease” is meant a lowering in the level of biological activity,as measured by inhibition of: a) the formation of enzymatically activemethionine synthase-cob(III)alamin-CH3 or methionine as a result ofmethionine synthase reductase activity; b) protein, as measured byELISA; c) reporter gene activity, as measured by reporter gene assay,for example, lacZ/β-galactosidase, green fluorescent protein,luciferase, etc.; or d) mRNA, as measured by PCR relative to an internalcontrol, for example, a “housekeeping” gene product such as β-actin orglyceraldehyde 3-phosphate dehydrogenase (GAPDH). In all cases, thedecrease is preferably by at least 10% more preferably by at least 25%,still more preferably by at least 50%, and even more preferably by atleast 70%.

By “an increase” is meant a rise in the level of biological activity, asmeasured by a stimulation of: a) the formation of methioninesynthase-cob(III)alamin-CH3 or methionine as a result of methioninesynthase reductase activity; b) protein, as measured by ELISA; c)reporter gene activity, as measured by reporter gene assay, for example,lacZ/β-galactosidase, green fluorescent protein, luciferase, etc.; or d)mRNA, as measured by PCR relative to an internal control, for example, a“housekeeping” gene product such as β-actin or glyceraldehyde3-phosphate dehydrogenase (GAPDH). Preferably, the increase is by atleast 10%, more preferably by at least 25%, still more preferably by atleast 75%, even more preferably by 2-fold, and most preferably by atleast 3-fold.

By “alteration in the level of gene expression” is meant a change ingene activity such that the amount of a product of the gene, i.e., mRNAor polypeptide, is increased or decreased, or that the stability of themRNA or the polypeptide is increased or decreased.

By “reporter gene” is meant any gene that encodes a product whoseexpression is detectable and/or quantitatable by immunological,chemical, biochemical or biological assays. A reporter gene product may,for example, have one of the following attributes, without restriction:fluorescence (e.g., green fluorescent protein), enzymatic activity(e.g., lacZ/β-galactosidase, luciferase, chloramphenicolacetyltransferase), toxicity (e.g., ricin A), or an ability to bespecifically bound by a second molecule (e.g., biotin or adetectably-labelled antibody). It is understood that any engineeredvariants of reporter genes, which are readily available to one skilledin the art, are also included, without restriction, in the forgoingdefinition.

By “protein” or “polypeptide” or “polypeptide fragment” is meant anychain of more than two amino acids, regardless of post-translationalmodification (e.g., glycosylation or phosphorylation), constituting allor part of a naturally-occurring polypeptide or peptide, or constitutinga non-naturally occurring polypeptide or peptide.

By “missense mutation” is meant the substitution of one purine orpyrimidine base (i.e. A, T, G, or C) by another within a nucleic acidsequence, such that the resulting new codon may encode an amino aciddistinct from the amino acid originally encoded by the reference (e.g.wild-type) codon.

By “deletion mutation” is meant the deletion of at least one nucleotidewithin a polynucleotide coding sequence. A deletion mutation alters thereading frame of a coding region unless the deletion consists of one ormore contiguous 3-nucleotide stretches (i.e. “codons”). Deletion of acodon from a nucleotide coding region results in the deletion of anamino acid from the resulting polypeptide.

By “frameshift mutation” is meant the insertion or deletion of at leastone nucleotide within a polynucleotide coding sequence. A frameshiftmutation alters the codon reading frame at and/or downstream from themutation site. Such a mutation results either in the substitution of theencoded wild-type amino acid sequence by a novel amino acid sequence, ora premature termination of the encoded polypeptide due to the creationof a stop codon, or both.

By “low serum cobalamin level” is meant a serum cobalamin concentrationof less than 328 pmol/L in a child, fetus, or embryo that has a neuraltube defect or is at risk for developing a neural tube defect, or aserum cobalamin concentration of less than 259 pmol/L in the mother orfuture parent of a child having a neural tube defect.

By “polymorphic methylenetetrahydrofolate reductase” or “mutantmethylenetetrahydrofolate reductase” is meant methylenetetrahydrofolatereductase (MTHFR) polypeptide or nucleic acid having a sequence thatconfers an increased risk of a disease phenotype in at least somegenetic and/or environmental backgrounds, for example, in combinationwith an MMTR polymorphism or mutation.

By “677C→T polymorphism in MTHFR” is meant a substitution of cytosine inplace of thymine in nucleic acid encoding MTHFR at a nucleotide positionequivalent to MTHFR nucleotide position 677 as disclosed in Frosst etal. (Nat. Genet. 10:111-113, 1995) and in Genbank Accession No. U09806(SEQ ID NO: 51).

By “future parent” is meant a male or female who has contributed or maypotentially contribute genetic material (e.g., a sperm or an egg) toform a zygote. A future parent is also a female who gestates or maypotentially gestate an embryo or fetus in her uterus, irrespective ofwhether she has contributed or may potentially contribute geneticmaterial to the embryo or fetus; an example of such a future parent is asurrogate mother).

By “test subject” is meant a future parent as defined above, an embryo,or a fetus.

By “sample from a test subject” is meant a specimen, for example, andnot limited to, blood, serum, cells, or amniotic fluid, that would allowone of skill in the art to determine whether the test subject has amutant or polymorphic methionine synthase reductase.

By “cardiovascular disease” is meant cardiovascular disease associatedwith elevated plasma homocysteine as described in (Rozen, Clin. Invest.Med. 19:171-178, 1996). As used herein, the term cardiovascular diseaseincludes premature coronary artery disease.

DETAILED DESCRIPTION OF THE INVENTION

Methionine synthase catalyzes the remethylation of homocysteine tomethionine in a reaction in which methylcobalamin serves as anintermediate methyl carrier.

Over time, the cob(I)alamin cofactor of methionine synthase may becomeoxidized to cob(II)alamin, thus rendering the enzyme inactive.Regeneration of the functional enzyme occurs through the reductivemethylation of the cob(II)alamin in a reaction in whichS-adenosylmethionine is utilized as methyl donor (FIG. 1). The reductiveactivation system in the lower part of the scheme shown in FIG. 1 is themechanism by which S-adenosylmethionine (Ado-Met) together with anelectron reactivates the enzyme to the functional, methioninesynthase-CH3-Co(III) state, resulting in the formation ofS-adenosylhomocysteine (Ado-Hcy) as a reaction by-product.

Patients of the cblE complementation group of disorders offolate/cobalamin metabolism, who are defective in the reductiveactivation of methionine synthase, have megaloblastic anemia,developmental delay, hyperhomocysteinemia, and hypomethioninemia. Wehave cloned a cDNA corresponding to the “methionine synthase reductase”reducing system required for maintenance of the methionine synthase in afunctional state. Using primers comprising sequences of consensusbinding sites for FAD, FMN and NADPH, we performed RT-PCR and inversePCR to clone a methionine synthase reductase cDNA. The cDNA hybridizesto an mRNA of 3.6 kb (as detected by Northern blot). The deduced proteinis a novel member of the FNR family of electron transferases, containing698 amino acids with a predicted Mr of 77,700. It shares 38% identitywith human cytochrome P450 reductase and 43% with the C. elegansputative methionine synthase reductase (see below). Methionine synthasereductase was localized to human chromosome 5p 15.2-15.3 by fluorescencein situ hybridization (FISH).

A survey of the NCBI databases for homology to the human methioninesynthase reductase using BLASTP or TBLASTN yielded the putativemethionine synthase reductase of C. elegans (P value=9×10-92). Proteinsof the FNR family were also found using the BLAST programs. Thestrongest homology was found with cytochrome P450 reductase (Pvalues>3×10-68), followed by nitric oxide synthase (three isoforms, Pvalues>4×10-52), and sulfite reductase (P values>6×10-39). Lower, butstill significant homology was found with E. coli NADPH-ferredoxin(flavodoxin) reductase (P values>2×10-9) and flavodoxin (Pvalues>3×10-2). Our finding suggests a convergent evolution of thetwo-gene flavodoxin/NADPH-ferredoxin (flavodoxin) reductase system to asingle gene encoding a fused version of the two proteins in human cells.Alignment of the proteins provides for a large linker region bridgingthe two components.

The identity of our cloned cDNA sequence as that encoding methioninesynthase reductase was confirmed by the identification of mutations inthe corresponding gene in cblE patients having a functional deficiencyof methionine synthase. Our key finding confirming the identification ofthe cDNA was a 4 bp frameshift mutation in two affected siblings. Theoccurrence of a functionally null mutation in a candidate gene providescompelling evidence that the mutation is causative of disease in theaffected patients. Furthermore, a 3 bp deletion detected in a thirdpatient is also highly likely to cause an enzyme defect, and the directsequencing of PCR products suggested that the patient's second allelecontains a mutation that renders the mRNA very unstable or poorlytranscribed. In all, seven of ten tested cblE cell lines showed evidenceof mutation although the sequence changes have yet to be determined inthe remaining four.

The two mutations we have identified associated with cblE disease arelocated in the vicinity of the NADPH binding domain by comparison withproteins of the FNR family. The 4 bp deletion yields a truncated proteinthat is expected to be deficient in NADPH binding and possibly in FADbinding, since the C-terminus of the enzyme may be involved in both. The3 bp deletion results in the deletion of Leu576, which is locatedbetween two sequences that may be involved in NADPH binding. Leu576 iswell conserved among reductases that are similar to the methioninesynthase reductase (FIG. 6C). This supports the idea that deletion ofthe Leu576 codon (1726delTTG) results in an enzymatic defect, althoughconfirmation will require expression of the mutant protein. This residueis also conserved in the NADPH-ferredoxin (flavodoxin) reductase enzymesof several organisms, although the homology with this portion of theprotein is low or absent in some cases. It is possible that the deletionaffects the relationship between the two NADPH-binding sequences thatare in its vicinity.

The cloning of human methionine synthase reductase cDNA enables thedetermination of the enzymatic mechanism involved in the reductiveactivation of methionine synthase. Furthermore, it is now possible toidentify additional mutations in patients with severe deficiency of theenzyme activity, and to determine whether there exist common amino acidpolymorphisms which lead to mildly elevated homocysteine levels. Suchelevations may be a risk factor in cardiovascular disease, neural tubedefects, and cancer.

Mutations in the human methionine synthase reductase gene that result inaltered homocysteine and/or folate levels may be risk factors for thediseases listed above. The methods of the invention therefore providediagnostic assays for such risk factors, as well as methods of treatingor preventing cardiovascular disease, neural defects, cancer,megaloblastic anemia, and hypomethioninemia. In addition, the inventionprovides methods for screening assays for the isolation of potentialtherapeutic compounds that modulate methionine synthase reductaseactivity.

The assays described herein can be used to test for compounds thatmodulate methionine synthase activity and hence may have therapeuticvalue in the prevention of neural tube defects, prevention and/ortreatment of cancer, cardiovascular disease, homocysteinemia, andmegaloblastic anemia.

Test Compounds

In general, novel drugs for prevention of neural tube defects, orprevention and/or treatment of cancer, cardiovascular disease, andmegaloblastic anemia are identified from large libraries of both naturalproduct or synthetic (or semi-synthetic) extracts or chemical librariesaccording to methods known in the art. Those skilled in the field ofdrug discovery and development will understand that the precise sourceof test extracts or compounds is not critical to the screeningprocedure(s) of the invention. Accordingly, virtually any number ofchemical extracts or compounds can be screened using the exemplarymethods described herein. Examples of such extracts or compoundsinclude, but are not limited to, plant-, fungal-, prokaryotic- oranimal-based extracts, fermentation broths, and synthetic compounds, aswell as modification of existing compounds. Numerous methods are alsoavailable for generating random or directed synthesis (e.g.,semi-synthesis or total synthesis) of any number of chemical compounds,including, but not limited to, saccharide-, lipid-, peptide-, andnucleic acid-based compounds. Synthetic compound libraries arecommercially available from Brandon Associates (Merrimack, N.H.) andAldrich Chemical (Milwaukee, Wis.). Alternatively, libraries of naturalcompounds in the form of bacterial, fungal, plant, and animal extractsare commercially available from a number of sources, including Biotics(Sussex, UK), Xenova (Slough, UK), Harbor Branch Oceangraphics Institute(Ft. Pierce, Fla.), and PharmaMar, U.S.A. (Cambridge, Mass.). Inaddition, natural and synthetically produced libraries are produced, ifdesired, according to methods known in the art, e.g., by standardextraction and fractionation methods. Furthermore, if desired, anylibrary or compound is readily modified using standard chemical,physical, or biochemical methods.

In addition, those skilled in the art of drug discovery and developmentreadily understand that methods for dereplication (e.g., taxonomicdereplication, biological dereplication, and chemical dereplication, orany combination thereof) or the elimination of replicates or repeats ofmaterials already known for their therapeutic activities forhomocysteinemia, megaloblastic anemia, cardiovascular disease, cancer,and neural tube defects should be employed whenever possible.

When a crude extract is found to modulate methionine synthase reductasebiological activity, further fractionation of the positive lead extractis necessary to isolate chemical constituents responsible for theobserved effect. Thus, the goal of the extraction, fractionation, andpurification process is the careful characterization and identificationof a chemical entity within the crude extract that modulates methioninesynthase reductase biological activity. The same assays described hereinfor the detection of activities in mixtures of compounds can be used topurify the active component and to test derivatives thereof. Methods offractionation and purification of such heterogenous extracts are knownin the art. If desired, compounds shown to be useful agents fortreatment are chemically modified according to methods known in the art.Compounds identified as being of therapeutic value may be subsequentlyanalyzed using mammalian models of homocysteinemia, megaloblasticanemia, cardiovascular disease, cancer, and neural tube defects.

Methionine Synthase Reductase Assays for the Detection of Compounds thatModulate Methionine Synthase Reductase Activity and Expression

Potentially useful therapeutic compounds that modulate (e.g. increase ordecrease) methionine synthase reductase activity or expression may beisolated by various screens that are well-known to those skilled in theart. Such compounds may modulate methionine synthase reductaseexpression at the pre- or post-transcriptional level, or at the pre- orpost-translational level.

A. Screens for Compounds that Modulate Methionine Synthase ReductaseEnzymatic Activity

Screens for potentially useful therapeutic compounds that modulatemethionine synthase reductase activity may be readily performed. Forexample, the effect of a test compound on methionine synthase reductaseactivity may be determined by measuring formation of¹⁴CH₃-cob(III)alamin, which results from the transfer of ¹⁴CH₃ fromS-adenosylmethionine to methionine synthase-cob(II)alamin. A testcompound that increases the enzymatic activity of a methionine synthasereductase would result in increased levels of methioninesynthase-¹⁴CH₃-cob(III)alamin, and a compound that decreases theenzymatic activity of a methionine synthase reductase would result indecreased levels of methionine synthase-¹⁴CH₃-cob(III)alamin.

The effect of a test compound on methionine synthase reductase activityalso may be determined by measuring the resulting activity of methioninesynthase. The amount of reaction product (i.e., methionine) formationreflects the relative activity of methionine synthase, which in turnreflects the relative activity of methionine synthase reductase, whichin turn indicates the effect of the test compound on methionine synthasereductase activity. For example, a sample containing methionine synthaseand homocysteine may contain a mutant, inactive methionine synthasereductase which does not reduce oxidized methionine synthase, and hence,no methionine is formed. However, a test compound that increases theenzymatic activity of the mutant methionine synthase reductase willresult in increased levels of methionine formation, relative to controlsamples not containing the test compound. Analogously, a compound thatdecreases methionine synthase reductase activity will result in theformation of decreased levels of methionine formation in reactionscontaining active methionine synthase reductase. That a test compounddirectly modulates methionine synthase reductase enzymatic activity, asopposed to methionine synthase enzymatic activity, can be confirmed byincluding control reactions that lack methionine synthase reductase.Such control reactions should not show altered levels of methionineproduction if the test compound directly modulates methionine synthasereductase activity.

Examples of methionine synthase activity assays, in vitro and in wholecells, are well-known to those skilled in the art (see, for example,Gulati et al., 1997, J. Biol. Chem. 272:19171-19175; see also Rosenblattet al., 1984, J. Clin. Invest. 74:2149-2156).

B. ELISA for the Detection of Compounds that Modulate MethionineSynthase Reductase Expression

Enzyme-linked immunosorbant assays (ELISAs) are easily incorporated intohigh-throughput screens designed to test large numbers of compounds fortheir ability to modulate levels of a given protein. When used in themethods of the invention, changes in a given protein level of a sample,relative to a control, reflect changes in the methionine synthasereductase expression status of the cells within the sample. Protocolsfor ELISA may be found, for example, in Ausubel et al., CurrentProtocols in Molecular Biology, John Wiley & Sons, New York, N.Y., 1997.Lysates from cells treated with potential modulators of methioninesynthase reductase expression are prepared (see, for example, Ausubel etal., supra), and are loaded onto the wells of microtiter plates coatedwith “capture” antibodies specific for methionine synthase reductase.Unbound antigen is washed out, and a methionine synthasereductase-specific antibody, coupled to an agent to allow for detection,is added. Agents allowing detection include alkaline phosphatase (whichcan be detected following addition of colorimetric substrates such asp-nitrophenolphosphate), horseradish peroxidase (which can be detectedby chemiluminescent substrates such as ECL, commercially available fromAmersham) or fluorescent compounds, such as FITC (which can be detectedby fluorescence polarization or time-resolved fluorescence). The amountof antibody binding, and hence the level of a methionine synthasereductase polypeptide within a lysate sample, is easily quantitated on amicrotiter plate reader.

As a baseline control for methionine synthase reductase expression, asample that is not exposed to test compound is included. Housekeepingproteins are used as internal standards for absolute protein levels. Apositive assay result, for example, identification of a compound thatincreases or decreases methionine synthase reductase expression, isindicated by an increase or decrease in methionine synthase reductasepolypeptide within a sample, relative to the methionine synthasereductase level observed in cells which are not treated with a testcompound.

C. Reporter Gene Assays for Compounds that Modulate Methionine SynthaseReductase Expression

Assays employing the detection of reporter gene products are extremelysensitive and readily amenable to automation, hence making them idealfor the design of high-throughput screens. Assays for reporter genes mayemploy, for example, colorimetric, chemiluminescent, or fluorometricdetection of reporter gene products. Many varieties of plasmid and viralvectors containing reporter gene cassettes are easily obtained. Suchvectors contain cassettes encoding reporter genes such aslacZ/β-galactosidase, green fluorescent protein, and luciferase, amongothers. Cloned DNA fragments encoding transcriptional control regions ofinterest (e.g. that of the mammalian methionine synthase reductase gene)are easily inserted, by DNA subcloning, into such reporter vectors,thereby placing a vector-encoded reporter gene under the transcriptionalcontrol of any gene promoter of interest. The transcriptional activityof a promoter operatively linked to a reporter gene can then be directlyobserved and quantitated as a function of reporter gene activity in areporter gene assay.

Cells are transiently- or stably-transfected with methionine synthasereductase control region/reporter gene constructs by methods that arewell known to those skilled in the art. Transgenic mice containingmethionine synthase reductase control region/reporter gene constructsare used for late-stage screens in vivo. Cells containing methioninesynthase reductase/reporter gene constructs are exposed to compounds tobe tested for their potential ability to modulate methionine synthasereductase expression. At appropriate timepoints, cells are lysed andsubjected to the appropriate reporter assays, for example, acolorimetric or chemiluminescent enzymatic assay forlacZ/β-galactosidase activity, or fluorescent detection of GFP. Changesin reporter gene activity of samples treated with test compounds,relative to reporter gene activity of appropriate control samples,indicate the presence of a compound that modulates methionine synthasereductase expression.

D. Quantitative PCR of Methionine Synthase Reductase mRNA as an Assayfor Compounds that Modulate Methionine Synthase Reductase Expression

The polymerase chain reaction (PCR), when coupled to a preceding reversetranscription step (rtPCR), is a commonly used method for detectingvanishingly small quantities of a target mRNA. When performed within thelinear range, with an appropriate internal control target (employing,for example, a housekeeping gene such as actin), such quantitative PCRprovides an extremely precise and sensitive means of detecting slightmodulations in mRNA levels. Moreover, this assay is easily performed ina 96-well format, and hence is easily incorporated into ahigh-throughput screening assay. Cells are treated with test compoundsfor the appropriate time course, lysed, the mRNA is reverse-transcribed,and the PCR is performed according to commonly used methods, (such asthose described in Ausubel et al., Current Protocols in MolecularBiology, John Wiley & Sons, New York, N.Y., 1997), using oligonucleotideprimers that specifically hybridize with methionine synthase reductasenucleic acid. Changes in product levels of samples exposed to testcompounds, relative to control samples, indicate test compounds thatmodulate methionine synthase reductase expression.

Secondary Screens of Test Compounds that Appear to Modulate MethionineSynthase Reductase Activity

After test compounds that appear to have methionine synthasereductase-modulating activity are identified, it may be necessary ordesirable to subject these compounds to further testing. At late stagestesting will be performed in vivo to confirm that the compoundsinitially identified to affect methionine synthase reductase activitywill have the predicted effect in vivo. Such tests may be performedusing cells or animals that have wild-type, mutated, or deletedmethionine synthase reductase genes, or wild-type or mutated methioninesynthase reductase transgenes.

Therapy

Compounds identified using any of the methods disclosed herein, may beadministered to patients or experimental animals with apharmaceutically-acceptable diluent, carrier, or excipient, in unitdosage form. Conventional pharmaceutical practice may be employed toprovide suitable formulations or compositions to administer suchcompositions to patients or experimental animals. Although intravenousadministration is preferred, any appropriate route of administration maybe employed, for example, parenteral, subcutaneous, intramuscular,intracranial, intraorbital, ophthalmic, intraventricular, intracapsular,intraspinal, intracisternal, intraperitoneal, intranasal, aerosol, ororal administration. Therapeutic formulations may be in the form ofliquid solutions or suspensions; for oral administration, formulationsmay be in the form of tablets or capsules; and for intranasalformulations, in the form of powders, nasal drops, or aerosols.

Methods well known in the art for making formulations are found in, forexample, “Remington's Pharmaceutical Sciences.” Formulations forparenteral administration may, for example, contain excipients, sterilewater, or saline, polyalkylene glycols such as polyethylene glycol, oilsof vegetable origin, or hydrogenated naphthalenes. Biocompatible,biodegradable lactide polymer, lactide/glycolide copolymer, orpolyoxyethylene-polyoxypropylene copolymers may be used to control therelease of the compounds. Other potentially useful parenteral deliverysystems for antagonists or agonists of the invention includeethylene-vinyl acetate copolymer particles, osmotic pumps, implantableinfusion systems, and liposomes. Formulations for inhalation may containexcipients, for example, lactose, or may be aqueous solutionscontaining, for example, polyoxyethylene-9-lauryl ether, glycocholateand deoxycholate, or may be oily solutions for administration in theform of nasal drops, or as a gel.

The following examples are to illustrate, not limit the invention.

EXAMPLE 1 General Methods

Materials

Radiolabeled compounds were from DuPont (Wilmington, Del.). A humanmultiple tissue Northern blot and β-actin probe were from Clontech (PaloAlto, Calif.). The random-primed DNA labelling kit was from BoehringerMannheim (Indianapolis, Ind.). The T/A cloning kit was from Invitrogen(Carlsbad, Calif.), the Geneclean III kit was obtained from Bio101 Inc.(Vista, Calif.), and the Wizard Mini-Preps were from Promega (Madison,Wis.). Taq polymerase, AMV reverse transcriptase, Trizol reagent, andwere purchased from Gibco BRL (Gaithersburg, Md.), and restrictionenzymes were purchased from Gibco BRL and New England Biolabs (Beverly,Mass.). The Sequenase kits for manual sequencing of crude PCR productsor plasmids were from United States Biochemicals (Cleveland, Ohio). Theoligonucleotides (SEQ ID NOs: 3-20 and 49-50) were synthesized by ACGTCorporation (Toronto, Canada) or by the Sheldon Biotechnology Centre,McGill University. The sequences of oligonucleotides are shown in Table1 and in FIG. 2. A human cDNA library, made in Lambda-ZAP from RNAderived from the human colon carcinoma line Caco-2, was used as templatein some PCR reactions to obtain 5′ extensions of the cDNA.

Homology Matches

Comparisons were made between putative FMN, FAD and NADPH binding sitesand sequences in the NCBI databases (dbEST and nr) using the BLASTprograms (Altschul et al., Nat. Genet. 6:119-129, 1994). The cytochromeP450 reductase and nitric oxide synthase full sequences were also usedfor homology searching.

PCR Cloning and DNA Sequencing

Total cellular RNA was isolated by the method of Chirgwin et al.(Biochemistry, 18:5294-5299, 1979) and reverse-transcribed usingoligo-dT15 as primer. PCR was conducted as described previously (Triggset al., Am. J. Hum. Genet. 49:1041-1054, 1991). The PCR products werepurified using Geneclean, subcloned in the pCR2.1 vector and transformedinto E. coli according to the supplier's protocol (TA cloning kit). Theresulting clones were sequenced manually to confirm the specificity ofPCR products. Automated sequencing was done by Bio S&T Inc. (Montreal,Canada) or by the DNA Sequencing Core Facility of the Canadian GeneticDiseases Network.

Northern Blot

The multiple tissue Northern blot, prepared from poly(A)+ RNA (2μg/lane) of the indicated human tissues, was probed with an EcoRIsegment of a subclone in pCRII containing an insert spanning positions335-2148 of the methionine synthase reductase cDNA. Hybridization withhuman β-actin cDNA served as a control for the quantity and integrity ofthe RNA in the blot.

Chromosomal Localization

We performed PCR analysis of DNA from the NIGMS human/rodent somaticcells hybrid mapping panel (#2). The oligonucleotide primers, which werespecific for the 3′-UTR region of the gene, amplified a 111 nucleotideproduct (accession #G19837 in dbSTS). A P1-derived artificial chromosome(PAC) clone (104K2) was identified from a total human genomic library(Ioannou, P. A. et al., Nat. Genet. 6:84-89, 1994) by hybridizationscreening with a methionine synthase reductase cDNA probe (clone 704947,accession #AA279726 in dbEST) and this genomic clone was then used forFISH mapping (Heng, H. H. et al., Proc. Natl. Acad. Sci. USA89:9509-9513, 1992; Heng, H. H and Tsui, L. C., Chromosoma 102:325-332,1993).

Cell Lines

Ten fibroblast cell lines from patients with homocystinuria (cblEcomplementation group) were used to identify mutations and polymorphismsin the MTRR gene using reverse transcription-PCR of total cellular RNA.Three of the cell lines displayed mutations: WG788 from the originalcblE patient (Schuh et al., N. Engl. J. Med. 310:686-690, 1984); WG1146from his younger brother, who had been diagnosed before birth, and whosemother was treated with hydroxocobalamin during pregnancy (Rosenblatt etal., Lancet 1:1127-1129, 1985); and WG1836 from a patient who hadpreviously been described as having dihydrofolate reductase deficiency(case 1 in Tauro et al., N. Engl. J. Med. 294:466, 1976) andsubsequently as having a “new mutation” associated with lowmethylcobalamin levels and reduced cellular folate uptake (Brasch et al,Aust. N. Z. J. Med. 18 Supp. 434, 1988). In our laboratory, we haveshown that the fibroblast line from this last patient falls into thecblE complementation group.

The fibroblast cell line WG1401 was the first to show the polymorphism,an A to G substitution at bp 66. WG1401 is from patient B.S.S. 17, withmegaloblastic anemia, hyperhomocysteinemia, and mild methylmalonicaciduria. The polymorphism was also found in a control cell line, MCH64.

Twenty-two other cell lines were used as normal controls for mutationanalysis.

Mutation Analysis by RT-PCR of Fibroblast RNA

Total cellular RNA was isolated from fibroblast pellets (Chirgwin etal., Biochemistry, 18:5294-5299, 1979). It was reverse transcribed using25 μg total RNA in reactions containing 2.5 U of AMV reversetranscriptase and 500 ng of methionine synthase reductase-specificterminal oligonucleotide 2101C (SEQ ID NO: 20; Table 1) in a totalreaction volume of 54 μl. The resultant cDNA was used as template forPCR. PCR for nine overlapping cDNA segments was performed in reactionscontaining 3 μl of template, 1 μl each of dTTP, dGTP, dATP and dCTP (10mM), and 3 U Taq polymerase in a 46 μl volume. PCR products wereverified by agarose gel electrophoresis before testing for heteroduplexformation. Heteroduplex analysis was carried out by mixing mutant andcontrol PCR products 1:1, heating the mixture to 95° C. for 3 min,cooling to room temperature, and subjecting the samples toelectrophoresis on an 8% polyacrylamide gel. Fragments displaying shiftswere subcloned and sequenced, or sequenced directly.

MMTR Polymorphism Analysis in Genomic DNA Samples

For the screening of genomic DNA samples, restriction digestion analysiswas performed with an artificially-created NdeI restriction site usingthe sense primer MSG108S 5′GCAAAGGCCATCGCAGAAGACAT (SEQ ID NO: 49) andantisense primer AD292 5′GTGAAGATCTGCAGAAAATCCATGTA (SEQ ID NO: 50),where the underlined C replaces the A to generate an NdeI restrictionsite in the normal sequence. To test for the mutation, 10 μl of PCRproduct was digested by adding 6 μl H2O, 2 μl New England Biolab's (NEB)buffer 4 and 2 μl NdeI. The PCR fragment of 66 bp remains uncut in thepresence of the G (methionine) allele, but is digested into fragments of44 bp and 22 bp in the presence of the A (isoleucine) allele.

Subjects

Patients with spina bifida (n=56) and mothers of children with spinabifida (n=58) were recruited from the Montreal Children's Hospital afterapproval of the protocol by the Institutional Review Board. The controls(n=97) were other outpatients who were having a venipuncture at thePediatric Test Center, Montreal Children's Hospital, and who were withtheir mothers (n=89). Blood samples were obtained from mothers andchildren after appropriate consent. Exclusion criteria were syndromicneural tube disorder (NTD) cases, severe anemia, neoplastic disease,renal insufficiency and immunosuppressive therapy. Individuals who weretaking vitamin supplements were also excluded. Themethylenetetrahydrofolate reductase (MTHFR) genotypes and the levels ofplasma homocysteine and serum cobalamin were previously determined inthese subjects. The concentration of serum cobolamin was quantitated byroutine methods, using an automated system and reagents from Ciba (CibaCorning Diagnostics Corp., Medfield, Mass.).

To determine total homocysteine (tHcy) levels in plasma, blood sampleswere drawn to Becton-Dickinson vacutainers containing sodium EDTA andkept on ice until plasma was separated. Plasma was separated bycentrifugation for 5 min., removed, and cetrifuged again; thesupernatant was collected and frozen at −20° C. until analysis. tHcy inplasma was determined by high pressure liquid chromatography as reported(Gilfix et al., Clin. Chem. 43:687-688, 1997). The tHcy adduct wasdetected by fluorescence after precolumn derivitization with thethiol-specific reagent 7-fluoro-benzo-2-oxa-1,3-diazole-4-sulphonate(SBD-F) (Wako, USA).

To detect the MTHFR polymorphism, DNA was isolated from peripheralleukocytes by extraction with phenol-chloroform after cell lysis in abuffer containing Nonidet-P40 (Boehringer Mannheim, Mannheim, Germany)and stored at −20° C. The presence of the 677C→T polymorphism in MTHFR(SEQ ID NO: 51) was determined by PCR followed by restriction digestionwith HinfI, as described (Frosst et al., Nat. Genet. 10:111-113, 1995).

Statistics

Computer-assisted statistical analyses were carried out using SAS forWindows (Version 6.12). Standard summary statistics, analysis ofvariance, t-tests, calculation of odds ratios with associated confidencelimits, and logistic regression models were used where appropriate.Statistical significance was interpreted as p-values of p<0.05.

EXAMPLE II Cloning of the Human Methionine Synthase Reductase cDNA

More than 20 overlapping sequences homologous to the FAD andNADPH-binding domains of cytochrome P450 reductase were identified in aninitial survey of the NCBI dbEST database using TblastN. We sequencedclones 550341 (accession #AA085543), 704947 (accession #AA279726) and31776 (accession #R17835) to confirm the sequence of this part of thecDNA. Reprobing the NCBI databases with this sequence yielded a C.elegans sequence (accession #Z35595) containing binding sites for FMN,FAD and NADPH. We then used the C. elegans sequence to reprobe the dbESTdatabase using TblastN and identified a human sequence (accession#AA192690, clone 628497) containing a putative FMN binding site similarto the one encoded by Z35595. We designed a sense primer based on theFMN binding region of AA192690 and antisense primers corresponding tothe FAD/NADPH binding regions of the methionine synthase reductasecandidate and amplified a sequence by RT-PCR using human fibroblasts asthe source of RNA. FIG. 2 shows the overlapping clones and PCR fragmentsused to clone and sequence human methionine synthase reductase. The ESTclones are shown as rectangles, the subsequences that were availablefrom the dbEST database are shown as hatched boxes, and the PCRfragments are represented as lines. The oligonucleotide names areindicated below the arrows in FIG. 2 and are described in Table 1 below.The primer in parentheses designates a mispriming outcome that generatedvalid internal sequence. The letter “V” in black boxes indicates primersannealing to the vector of the cDNA library used as a template for PCR.The presence of a triangle above a segment indicates that it contained adeletion of 154 bp (open triangle) or 26 bp (black triangle), likelycaused by alternative splicing. TABLE 1 Oligonucleotides used for cDNAcloning, mapping, and mutation detection. Primers Sequence Location Z116(SEQ ID NO: 3) 5′-CTCCTGCTCGAACATCTTCCTAAA 1318-1341 Z117 (SEQ ID NO: 4)5′-AATAGATAATCCCTATCCTTATGCC 1766-1742 AD150 (SEQ ID NO: 5)5′-CCCTGGCTCCTAAGATATCCATC 1544-1566 AD151 (SEQ ID NO: 6)5′-CGAACAACAAATTCTTTCCACTTACC 1573-1598 AB191 (SEQ ID NO: 7)5′-CAAGGTTGGTGGAAGTCGCGTTG −79-−57 AA468 (SEQ ID NO: 8)5′-ATGCCTTGAAGTGATGAGGAGGTTT −13-12  AB586 (SEQ ID NO: 9)5′-TTCCTACAACATAGAGAGAAACTC 1663-1686 AB588 (SEQ ID NO: 10)5′-TTGCACAAGGGCATCATGTACATC 1998-1975 Z593 (SEQ ID NO: 11)5′-AAACCTCCTCATCACTTCAAGGCAT  12-−13 Z594 (SEQ ID NO: 12)5′-CTTGCACACGAATATGGTCTGGG 1370-1348 Z596 (SEQ ID NO: 13)5′-TGGCATCACCTGCATCCTTGAGG 506-528 Z597 (SEQ ID NO: 14)5′-GATGTACCTGTAAATATTCTGGGGG 760-736 1103A (SEQ ID NO: 15)5′-AATCCACGGCTCAACCACAAGTTC 429-406 1761 (SEQ ID NO: 16)5′-CTCGAAATTAACCCTCACTAAAGGG in Bluescript 1803E (SEQ ID NO: 17)5′-AACCCATACCGCAGGTGAGCAAA 278-256 1812B (SEQ ID NO: 18)5′-TTTAGTACTTTCAGTCAAAAAAGCTTAAT 2148-2120 1902C (SEQ ID NO: 19)5′-ATAAACGACTTCAAGAGCTTGGAGC 335-359 2101C (SEQ ID NO: 20)5′-AGGTTTGGCACTAGTAAAGCTGACT 2173-2149 MSG108S (SEQ ID NO: 49)5′-GCAAAGGCCATCGCAGAAGACAT 43-65 AD292 (SEQ ID NO: 50)5′-GTGAAGATCTGCAGAAAATCCATGTA  83-108

The sequence of the PCR products confirmed that our cDNA contained theputative FMN, FAD and NADPH binding sites. The 5′ end of the sequencewas obtained by PCR using a cDNA library as template, with antisenseprimers specific for the cDNA and a sense primer that anneals to thevector used to construct the library. The sequences generated by PCRwere taken as error-free by comparison of the sequence of at least two,and usually three, independent PCR reactions.

The coding sequence of human methionine synthase reductase contains 2094bp (SEQ ID NO: 1 and SEQ ID NO: 41) encoding a polypeptide of 698 aminoacids (SEQ ID NO: 2 and SEQ ID NO: 42) in length. FIG. 3 shows the cDNAsequence (SEQ ID NO: 24) and deduced amino acid sequence of humanmethionine synthase reductase. The nucleotide residues are numbered onthe left margin, the amino acids residues are numbered on the rightmargin, and the stop codon is indicated by three stars. The sequence hasbeen deposited in the GenBank database, accession #AF025794.

The predicted MW of human methionine synthase reductase is 77,700. Itshares 38% sequence identity (49% similarity) with human cytochrome P450reductase (accession #A60557) and 43% identity (53% similarity) with theC. elegans putative methionine synthase reductase (accession #Z35595).FIG. 4 shows amino acid sequence comparisons among human methioninesynthase reductase (HsMTRR), C. elegans putative methionine synthasereductase (CeMTRR) and human cytochrome P450 reductase (HsCPR). Theamino acids residues are numbered on the right margin, and conservedresidues are shown by stars under the sequence. Alignments of similaramino acids are dotted (A, G, S, T; D, E, N, Q; V, L, I, M; K, R; and F,W, Y), and regions proposed to be involved in binding of FMN, FAD orNADPH are shown above the sequences.

The first in-frame methionine residue is a candidate for the initiationcodon. It is perfectly aligned with the first methionine of the C.elegans sequence, and the presence of a G at positions −3 and −6 placesthe sequence in good context for initiation of translation (Kozak, J.Biol. Chem. 266:19867-19870, 1991). A polyadenylation signal is presentat positions 3135-3140. The poly(A) tail is added after position 3165,although we observed some clones with polyadenylation after residue3157.

RT-PCR involving various pairs of primers allowed us to detectalternatively processed methionine synthase reductase mRNA, includingone form with a deletion of 154 bp (nucleotides 129-282) and anotherlacking a 26 bp segment (−52 to −27), accounting for less than 20% and40% of the mRNA, respectively.

EXAMPLE III Expression of Human Methionine Reductase mRNA

A PCR product generated with primers 1902C (SEQ ID NO: 19) and 1812B(SEQ ID NO: 18) was subcloned and used to probe a Northern blot preparedfrom several human tissues.

FIGS. 5A and 5B show a Northern blot analysis of methionine synthasereductase expression in human tissues, with the positions of themolecular size (kb) markers indicated at the left. The 1.8 kb probehybridized to one predominant RNA species of 3.6 kb. Methionine synthasereductase appears to be expressed to some degree in all tissues testedand is particularly abundant in skeletal muscle. In addition to the 3.6kb band, a 3.1 kb band and a faint 6 kb band were detected in brainmRNA.

EXAMPLE IV Chromosomal Mapping of the Human Methionine SynthaseReductase Gene

The methionine synthase reductase gene was localized to human chromosome5, since the gene-specific primer pair amplified a PCR product of theexpected size only from the GM 10114 hybrid, which contains chromosome 5as its only human material. Moreover, the DNA sequence we determined forthe methionine synthase reductase gene matched markers AA002A03 andSTSG444, which were also mapped by the NCBI consortium to chromosome 5between markers D5S406-D5S478 and D5S406-D5S635, respectively (Hudson,T. J. et al., Science 270:1945-1954, 1995). To determine the cytogeneticposition of the gene on chromosome 5, we mapped a genomic PAC cloneencompassing the gene using fluorescence in situ hybridization (FISH).FIG. 6 shows a summary of the FISH mapping of the methionine synthasereductase gene to human chromosome 5p15.2-p15.3. Each dot represents asignal detected on human chromosome 5. The hybridization efficiency was100%, and, among 100 mitotic figures examined, each result indicatedthat the gene was located on chromosome 5p15.2-p15.3. We propose MTRR asthe gene name for methionine synthase reductase, since the methioninesynthase gene has been named MTR.

EXAMPLE V Mutations of the Methionine Synthase Reductase Gene inPatients of the cblE Complementation Group

To confirm the identity of the candidate cDNA as methionine synthasereductase, patient cell lines from the cblE complementation group wereanalyzed by RT-PCR-dependent heteroduplex analysis using nine RT-PCRreactions that yielded overlapping products, in order to cover thelength of the candidate cDNA sequence. Patient samples were mixed withRT-PCR product from normal cells to ensure the availability of wild-typeDNA, in order to enable the detection of heteroduplexes in samples inwhich the mutation might be homozygous. For samples yieldingheteroduplexes, the analysis was repeated without prior mixing withwild-type DNA, in order to determine whether the relevant changes wereheterozygous. Three cell lines showed typical heteroduplex patterns, oneof them observed in overlapping RT-PCR fragments (FIGS. 7A and 7B).

FIGS. 7A and 7B show a mutation analysis of the methionine synthasereductase gene in cblE patient cell lines. FIG. 7A shows the PCRproducts obtained with primers Z116 (SEQ ID NO: 3) and Z117 (SEQ ID NO:4) from RT reactions with control sample (WT) and two cblE cell lines,WG1146 and WG1836. The bands above the 449 bp amplification productresult from heteroduplexes formed between DNA strands bearing differentallelic sequences. The pattern observed for cell line WG1146 was alsoseen with cell line WG788 (the sibling of WG1146). FIG. 7B shows RT-PCRproducts amplified with primers. AB586 (SEQ ID NO: 9) and AB588 (SEQ IDNO: 10) from a control sample and cell line WG1836. Heteroduplexes areobserved above the 336 bp band for cell line WG1836.

The heteroduplex-containing samples were subcloned and sequenced and twomutations were identified. A heterozygous mutation present in fibroblastline WG788 is a 4 bp deletion, 1675del4, resulting in a frameshift thatcreates a nearby stop codon. The same mutation was observed in cell lineWG1146 from the brother of patient WG788. Direct sequencing of the PCRproduct using primer AD150 showed overlapping sequences starting atposition 1675, consistent with the heterozygous presence of the 4 bpdeletion.

The second heterozygous mutation, detected in cell line WG1836, is anin-frame deletion of 3 bp, 1726delTTG. It results in the loss of ahighly conserved leucine at position 576 of the amino acid sequence.

FIG. 7C shows a sequence comparison among proteins of the FNR family ina part of the NADPH binding region in the vicinity of the leucineresidue that is deleted in a cblE patient (denoted by a triangle; MTRRis methionine synthase reductase; CPR is cytochrome P450 reductase; NOSis nitric oxide synthase; SR is sulfite reductase; and FNR isNADPH-ferredoxin (flavodoxin) reductase).

Primer AD151 (SEQ ID NO: 6) was used for direct sequencing of the WG1836PCR product. In this case, the deletion of nucleotides 1726-1728 wasclearly visible. There was only a very faint background contributed bythe normal sequence, suggesting that a second, unidentified mutation inthis cell line was associated with a very low level of steady-statemRNA.

EXAMPLE VI Human Methionine Synthase Reductase Polymorphisms

We have identified two polymorphisms in methionine synthase reductasecDNAs. The first is a G/A polymorphism at nucleotide position 66, usingthe “A” of the initiator methionine as nucleotide position number 1 (seeFIG. 3), which results in either an isoleucine or a methionine,respectively, at amino acid 22. The second polymorphism is a G/Apolymorphism at nucleotide position 110, which results in either atyrosine or a cysteine, respectively, at amino acid position 37. It islikely that additional methionine synthase reductase polymorphisms willbe found, some of which will be associated with increased or decreasedrisks of disease.

EXAMPLE VII A Common Polymorphism in Methionine Synthase Reductase as aRisk Factor for Spina Bifida

During screening for methionine synthase reductase (MTRR) mutations inpatients with homocystinuria, we identified an A/G polymorphism at bp66, which yields an isoleucine (22I) or a methionine (22M),respectively, at amino acid position 22 (FIG. 8A). Since the presence ofthe methionine polymorphism at this position did not create orobliterate a naturally-occurring restriction site, a PCR-dependentdiagnostic test was established that makes use of a modified senseprimer to create a NdeI site in the isoleucine allele during theamplification reaction. The PCR product of 66 bp remains uncut in thepresence of the methionine allele, but is digested into fragments of 44and 22 bp in the presence of the isoleucine allele (FIG. 8B). The cDNAsequence reported in Leclerc, et al., Proc. Natl. Acad. Sci. USA,95:3059-3064, 1998, contained the methionine codon.

The NdeI assay was used to assess allele frequencies in controls. The22I/22M polymorphism was extremely common in our control adultpopulation (mothers of control children, n=89). Forty-nine percent wereheterozygous while 26% were homozygous for the methionine allele (Table2). The allele frequency was 0.51 for the methionine variant. Similarfrequencies were observed for control children. The controls in thisstudy were white Caucasian individuals with French, British, and mixedEuropean ancestry. Since the allele frequency is virtually identical forthe two variants, the designation of a “wild type” allele could not beascertained based on frequency. However, this gene has significanthomology with related FMN-binding proteins from other organisms,including the putative methionine synthase reductase from C. elegans, aswell as sulfite reductases, nitric oxide synthases, cytochrome P450reductases, and flavodoxins. The equivalent codon in these genes isisoleucine, leucine, or valine in 123 out of 130 entries in GenBank.None of the entries contained a methionine codon. Consequently, theancestral human MTRR sequence is likely to contain the isoleucine codon(22I), with a subsequent mutation to methionine (22M).

In this study, 34% (19/56) of case (spina bifida) children and 36%(21/58) of case mothers were homozygous for the 22M polymorphism inMTRR, compared to 30% (29/97) of control children and 26% (23/89) ofcontrol mothers (Table 2). An increased risk for being a case (oddsratio (OR) 1.7, 95% confidence interval (CI) 0.67-4.6)) or a case mother(O.R. 2.0, 95% CI 0.77-5.2) was observed when the homozygous mutant(M/M) genotype was present, but this increase was not statisticallysignificant. Mother-child genotype pairs were also assessed for neuraltube defect (NTD) risk to determine if the combination of mutantmaternal and mutant child genotypes conferred a greater risk than eithergenotype alone; an increased risk was not observed. Homocysteine levelswere not increased in individuals who were homozygous mutant for MTRR(Table 3).

Synergistic Interaction Between MTRR Genotype and Cobalamin LevelInfluences the Risk of NTD

Case children had serum cobalamin levels (pmol/L) of 487±250 (n=55),whereas control children had serum cobalamin levels of 535±339 (n=95);case mothers had serum cobalamin levels of 298±186 (n=59), whereascontrol mothers had serum cobalamin levels of 350±135 (n=88; p=0.05). Wetherefore asked whether the mutant MTRR genotype may have a greaterimpact on NTD risk when cobalamin levels are low. Table 4 shows theresults of multiple logistic regression analysis, adjusted for age, totest this hypothesis. Having a cobalamin level in the lowest quartile ofthe control distribution was associated with a nonsignificant two-foldincrease in risk for the case mothers (O.R.=2.1; 95% CI=0.86-5.2). Therewas no increase in risk for low cobalamin in the children. However, thecombination of homozygous mutant genotype and low cobalamin wasassociated with a significant 5-fold increase in risk for the mothers,compared to those without the M/M genotype and with cobalamin levels inthe other 3 quartiles (O.R.=4.8, 95% CI=1.5-15.8). The risk for thechildren with this combination was also increased but statisticalsignificance was not observed (O.R.=2.5, 95% CI=0.63-9.7). There was noincreased risk for the mutant genotype combined with low folate. Becausethe MTRR genotype alone was associated with less risk, we speculate thatgenotype and cobalamin levels work in unison to produce increased riskfor spina bifida in the case mothers and case children.

Synergistic Interaction Between MTRR and MTHFR Genotypes Influences theRisk of NTD

The 677C→T polymorphism (SEQ ID NO: 51) in the methylenetetrahydrofolatereductase (MTHFR) gene converts an alanine to a valine residue in theenzyme (Frosst et al., Nat. Genet. 10:111-113, 1995). MTHFR catalyzesthe synthesis of 5-methyltetrahydrofolate, the primary circulatory formof folate and the methyl donor in the remethylation of homocysteine tomethionine by methionine synthase. Several studies have demonstrated anincreased frequency of the homozygous mutant (V/V) MTHFR genotype inchildren with NTDs and in their mothers (van der Put et al., Lancet346:1070-1071, 1995; Whitehead et al., Quart. J. Med. 88:763-766, 1995;Ou et al., Am. J. Med. Genet. 63:610-614, 1996).

Table 5 shows the interaction between the MTRR genotype and the MTHFRgenotype in NTD risk, as determined by multiple logistic regressionanalysis, adjusted for age. Using a genotype of either homozygous wildtype or heterozygous for MTRR and homozygous wild type for MTHFR as thereference, a risk nearly five times as great is conferred to casechildren (O.R.=4.9, 95% CI=1.1-21.8) and to case mothers (O.R.=5.0, 95%CI 0.8-31.3) when they are homozygous for both mutations. The risk forthe combination of mutant genotypes is clearly higher than either mutantgenotype alone, in both the cases and in their mothers. TABLE 2Frequency of MTRR genotypes in children with spina bifida (cases) and incase mothers. I/I I/M M/M Cases  9/56 (16%) 28/56 (50%) 19/56 (34%)Controls 24/97 (25%) 44/97 (45%) 29/97 (30%) Case mothers 10/58 (17%)27/58 (47%) 21/58 (36%) Control mothers 22/89 (25%) 44/89 (49%) 23/89(26%)O.R. for children, M/M vs. I/I = 1.7 (95% C.I. 0.67-4.6)O.R. for mothers, M/M vs. I/I = 2.0 (95% C.I. 0.77-5.2)

TABLE 3 Homocysteine levels stratified by MTRR genotype. (tHcy (μmol/L))I/I I/M M/M n n n Children 7.7 ± 2.8  8.2 ± 3.3 8.2 ± 3.1 33 72 48Mothers 9.7 ± 2.8 10.3 ± 4.7 9.4 ± 3.1 32 71 43

TABLE 4 Logistic regression analysis for NTD risk in children andmothers. Odds ratio > (95% C.I.) Cobalamin MTRR Genotype level ChildrenMothers I/I or I/M normal 1.0 (ref.) 1.0 (ref.) I/I or I/M low 0.92(0.37-2.3) 2.1 (0.86-5.2) M/M normal 1.1 (0.46-2.5) 1.5 (0.56-4.1) M/Mlow 2.5 (0.63-9.7) 4.8 (1.5-15.8)Odds ratios are adjusted by age of children and mothers respectively.Low cobalamin refers to the lowest quartile of the control distribution;normal refers to the other 3 quartiles.

TABLE 5 Logistic regression analysis for NTD risk in children andmothers. Odds ratio > (95% C.I.) MTHFR MTRR Genotype Genotype ChildrenMothers I/I or I/M A/A 1.0 (ref.) 1.0 (ref.) I/I or I/M V/V 0.82(0.18-3.7) 2.4 (0.69-8.3) M/M A/A 1.2 (0.34-4.5) 1.9 (0.61-5.7) M/M V/V4.9 (1.1-21.8) 5.0 (0.80-31.3)Odds ratios are adjusted by age of children and mothers respectively.

EXAMPLE VIII Human Methionine Synthase Reductase Mutations andPolymorphisms in Disease

Alterations in metabolism of folates, homocysteine, methionine, vitaminB12, and S-adenosylmethionine are associated with diseases such asmegaloblastic anemia and conditions such as hyperhomocysteinemia. Inturn, hyperhomocysteinemia may be associated with a higher than normalrisk for cardiovascular disease and neural tube defects. In addition,decreased folate levels may be predictive of a lower than normal riskfor cancer.

DNA samples from patients having a disease or developmental defect, suchas those mentioned above, are analyzed for mutations within themethionine synthase reductase coding region and/or transcriptionalcontrol regions, and serum folate, red blood cell folate, plasmahomocysteine, and serum cobalamin levels are measured. Patient samplesare compared to control samples.

The cloning of the methionine synthase reductase gene makes possible thedetermination of whether discrete mutations and polymorphisms inmethionine synthase reductase nucleic acid confer an increased risk for,or in contrast, protection against, diseases and conditions such ascardiovascular disease, cancer, and neural tube defects, (those of skillin the art will understand that polymorphisms and mutations may eitherincrease or decrease the relative risk of any given disease ordevelopmental defect). This collection of data in turn makes possiblethe development of diagnostic assays that predict whether a subject hasa higher than normal risk of developing a disease or of having offspringwith developmental defects. An understanding of disease-enhancing or-protective mutations allows the development of therapeutics thatappropriately modulate methionine synthase reductase activity.

EXAMPLE IX Association Between Variants in MTHFR and/or MTRR with Down'SSyndrome

We have identified an association between the identified polymorphism inmethionine synthase reductase (MTRR) (an A→G polymorphism at nucleotideposition 66), the identified polymorphism in methylenetetrahydrofolatereductase (MTHFR) (a C→T polymorphism at nucleotide 677 (SEQ ID NO: 51)that converts an alanine to a valine residue (Frosst et al., supra)) andDown's Syndrome. In the study presented in Table 6, the genotypes ofmothers of Down's Syndrome babies (DS mother) were compared to thegenotypes of mothers of normal babies. We found that mothers of Down'sSyndrome babies had a significant 2.49-fold greater likelihood of havinga homozygous mutation for the A→G polymorphism at nucleotide position66. In addition, we found that mothers of Down's Syndrome babies had a2.07 fold greater likelihood of having a heterozygous mutation or ahomozygous mutation in the MTHFR gene. Finally, we identified a positiveinteraction between the MTRR and MTHFR gene mutations. Table 6demonstrates that mothers with Down's Syndrome babies had an evengreater likelihood of having both the MTRR and MTHFR mutations thanhaving either the MTRR or MTHFR mutations alone. Mothers with Down'sSyndrome babies had a 3.71 fold greater likelihood of having both a MTRRand a MTHFR mutation than control mothers. This result indicates thatthe identified mutations are useful as genetic markers for detection ofDown's Syndrome in a fetus or embryo. Alternatively, these mutations canbe used to assess the risk of a particular mother of having a Down'sSyndrome baby.

EXAMPLE X Increased Risk for Premature Coronary Artery Disease

We investigated whether an A66G polymorphism in the MTRR gene isassociated with altered levels of homocysteine and/or the risk ofdeveloping premature coronary artery disease. The findings describedbelow suggest that the methionine synthase reductase homozygous GGgenotype is a risk factor for the development of premature coronaryartery disease (Relative risk 1.49; 95% CI: 1.10-2.03), by a mechanismindependent of the detrimental vascular effects of hyperhomocysteinemia.

Four hundred seventy eight Caucasian individuals undergoing cardiaccatheterization procedures at the Carolinas Heart Institute wererecruited into the study. All patient volunteers provided blood samplesfor the isolation of serum, plasma and DNA. Of the 478 consentingparticipants, 463 had complete MTRR genotype data (96.86%), and 180 ofthese patients were at risk for premature coronary artery disease (CAD)by having ages<58 years (38.88%). A total of 124 of these individuals atrisk (66.67%) had premature coronary artery disease (CAD) withsignificant atherosclerosis, defined as ≧50% occlusion of ≧1 majorartery or 20-50% occlusions in each of >2 major arteries. The remaining62 individuals (33.33%) were free of significant occlusions (<50%occlusion in ≦1 major artery), and therefore were defined as controls.Among the individuals with premature CAD 21/124 (16.94%) were female and103/124 (83.06%) were male. Of the 116/180 age-eligible studyparticipants reporting ethnicity (64.44%), the majority were of Britishor German descent. A summary of the characteristics of the population ofindividuals<58 years of age is presented in Table 7.

Arterial blood was collected in ACD (acid-citrate-dextrose) and serumvacutainer tubes (Beckton-Dickinson, Franklin Lanes, N.J.) andimmediately placed on ice (for <2 hours) prior to centrifugation at 3000rpm for 20 minutes. Plasma and serum were removed and stored in screwcap cryovials at 70° C. Plasma homocysteine, serum folate, and vitaminB₁₂ concentrations were measured at the Vascular Disease Interventionand Research Laboratory at the Oklahoma University Health ScienceCenter.

The region surrounding the MTRR 66A→G polymorphism was amplified by thepolymerase chain reaction using primersA:5′-CAGGCAAAGGCCATCGCAGAAGACAT-3′ (SEQ ID NO: 61) andB:5′-CACTTCCCAACCAAAATTCTTCAAAAG-3′ (SEQ ID NO: 62). The amplificationswere performed in a 50 μl volume, containing 200 ng genomic DNA, 10 mMTRIS, pH 8.8, 50 mM KCl, 1 mM each dNTP, 1 μM each primer and 2.5 U Taqpolymerase (Perkin-Elmer, Norwak, Conn.). PCR cycling conditions in aGeneAmp 2400 thermal cycler (Perkin-Elmer, Norwak, Conn.) were: 94° C.for 5 minutes, followed by 30 cycles of 94° C. for 0.5 minutes, 55° C.for 0.5 minutes, 72° C. for 0.5 minutes, and a final extension of 72° C.for 5 minutes. Primer A, containing a mismatch from the MTRR sequence(underlined) creates a NdeI site in the amplified DNA from allelescontaining the 66A→G polymorphism, digesting the 150 bp amplimer into123 and 27 bp fragments. The fragments were separated on a 2% Nusieve/1%agarose gel containing 0.6 μg/ml ethidium bromide.

Statistical analyses were performed using Stata Statistical Software(College Station, Tex.). Contingency table analysis with 3-levels ofgenotype were used for comparison of disease or genotype frequenciesbetween groups, with sided p-values from Pearson chi-square tests orfrom Fisher's Exact Test where expected cell frequencies were ≦5, trendtests from Cuzick's non-parametric test (Cuzick J. A, Statistics inMedicine (1985) 4:87-90) and non-parametric adjustments of relativerisks with the Mantel-Haenszel procedure. Kruskal-Wallace tests oranalysis of variance of lag transformed measurements was used to testfor differences in plasma tHcy, and serum folate and vitamin B₁₂ levelsbetween the three MTRR genotype levels, respectively. Logisticregression was used to model risk of premature CAD adjusted for othercovariates. Descriptive statistics including means and standarddeviations or counts and percentages were calculated. A p-value of lessthan 0.05 was considered statistically significant.

We found that MTRR genotype analysis from 58 healthy, unselectedCaucasian individuals from North Carolina revealed a genotypedistribution of 22.4% AA, 50% AG, and 27.6% GG, indicating the highfrequency of the 66A→G polymorphism in the local population.

We then determined if the MTRR genotype was associated with prematureCAD in our population of patients undergoing cardiac catheterizationprocedures. A 3×2 contingency table analysis displayed an associationbetween premature CAD and both male sex and MTRR genotype (p<0.0001)(Table 8). Among both males and females, individuals with the homozygousGG genotype were at greatest risk of developing premature CAD. Relativerisks (RR) of premature CAD, with Mantel-Haenszel adjustment for sex,were RR=1.49 (95% CI: 1.10, 2.03) for GG versus AA and RR=1.21 (95% CI:0.88, 1.65) for AG versus AA. Cuzick's non-parametric test for trend inpremature CAD risk across the ordered genotype groups yielded a p-valueof p=0.03.

A stratified analysis detected no appreciable modification of theassociation between MTRR GG genotype and premature CAD by MTHFR TTgenotype, with a Mantel-Haenszel adjustment relative risk for prematureCAD for the MTRR GG versus MTRR AA genotypes across MTHFR strata of 1.47(95% CI: 1.04-2.06) compared to the crude relative risk of premature CADof 1.38 for the MTRR GG versus MTRR AA genotypes.

As summarized in Table 9, no substantial differences in the mean fastingplasm tHcy, serum folate, or vitamin B₁₂ concentrations between thethree MTRR genotype levels were detected. Non-parametric Kruskal-Wallistests for difference in the distributions of continuous covariatesyielded p-values of 0.65 for tHcy, 0.18 for folate, and 0.69 for vitaminB₁₂. ANOVA models predicting log-transformed continuous variables withadjustment for sex yielded p-values for MTRR level of 0.62 for tHcy,0.25 for folate, and 0.79 for vitamin B₁₂.

We next examined the influence of vitamin B₁₂ status on the associationbetween MTRR genotype and premature CAD as well as with homocysteinelevel. The proportion of individuals with premature CAD within the threeMTRR genotype groups did not differ among those with vitamin B₁₂ levelsabove and below the median value of 300 pg/mL (AA-58.8% versus 55.6%,n=35; AG-63.8% versus 67.5%, n=87; GG-77.3% versus 80.8%, n=48). Theoverall p-value for premature CAD by vitamin B₁₂ levels above and belowthe median was 0.91, and adjustment for sex and MTRR level vial logisticregression yielded a p-value for vitamin B₁₂ levels above and below themedian of 0.79.

When combining case and control individuals, those with B₁₂ values belowthe median were found to have higher tHcy concentrations (p=0.003).Individuals with B₁₂ values below the median had higher tHcyconcentrations within each stratum of MTRR genotype. The differences inμmol/L and p-values from Wilcox on rank sum tests for AA, AG and GGgenotypes were 1.3 (p=0.049), 1.5 (p=0.031), and 1.6 (p=0.35),respectively.

The MTRR GG genotype was significantly associated with premature onsetcoronary artery disease in the study population. This association ofgenotype with disease was not modulated by vitamin B₁₂ status or MTHFRgenotype. Without limiting the biochemical mechanism of the invention,we propose that the mechanism by which possession of the GG genotypepredisposes a subject to CAD does not appear to be related to theeffects of hyperhomocyteinemia, as there was no difference in tHcyconcentrations between the MTRR genotype levels. An inverse relationshipbetween vitamin B₁₂ concentration and tHcy levels was detected withinthe MTRR genotype groups, supporting previous reports of an inverserelationship between homocysteine and vitamin B₁₂ levels (Verhoef et al.Am. J. Epidenm (1996) 143:845-859; Folsom et al., Circulation (1998)98:204-210).

These results indicate that the identified mutations are useful asgenetic markers for detection of premature cardiovascular disease in afetus or embryo. Alternatively, these mutations can be used to assessthe risk of a particular mother of having a baby that might, in thefuture, develop premature cardiovascular disease. TABLE 6 Associationbetween variants in MTHFR or MTKR or both with Down's Syndrome (DS)Interaction between MTHFR and MTRR gene mutations MTHFR MTRR control DSmother Odds ratio (95% CI) − − 55 29 1 (reference) + − 59 65 2.07(1.17-3.66) − + 15 20 2.49 (1.12-5.52) + + 19 38 3.71 (1.84-7.51) Total148 152MTHFR− = Homozygous normalMTHFR+ = Heterozygous mutation and homozygous mutation combinedMTRR− = Homozygous normal and heterozygous mutation combinedMTRR+ = Homozygous mutation

TABLE 7 Comparison of characteristics among cases with coronaryartherosclerosis versus control subjects. Individuals <58 years of age(n = 180) Patients Controls Sex - Male 99/119 (83.2%) 32/61 (52.5%) P <0.001 -Female 20/119 (16.8%) 29/61 (47.5%) Hypercholesterolemia 84/114(73.7%) 33/59 (55.9%) P = 0.03 Hypertension 69/117 (59.0%) 33/60 (55.0%)P = 0.63 Diabetes 26/118 (22.0%)  8/61 (13.1%) P = 0.17 Current smoker36/119 (30.3%) 15/61 (24.6%) P = 0.49

TABLE 8 Percentage of males and females <58 years of age with CAD byMTRR genotype. MTRR Males Females Genotype Cases Controls Cases ControlsAA 64.5% 35.5% 16.7% 83.3% (n = 20) (n = 11) (n = 1) (n = 5) AG 73.4%26.6% 39.3% 60.7% (n = 47) (n = 17)  (n = 11)  (n = 17) GG 88.9% 11.1%53.3% 46.7% (n = 32) (n = 4)  (n = 8) (n = 7)Cuzick's non-parametric test for trend in premature CAD risk across theordered genotype groups yielded a p-value of p = value of p = 0.03. RRof premature CAD = 1.49 (95% CI: 1.10, 2.03) for GG versus AA.

TABLE 9 Distribution of tHey, folate and vitamin B₁₂ concentrations bysex and MTRR genotype. MTRR AA MTRR AG MTRR GG Male Female Male FemaleMale Female Plasma 11.0 ± 2.3 10.0 ± 3.0 12.2 ± 4.6 9.5 ± 3.1 11.1 ± 4.4 9.8 ± 2.8 tHcy (μmol/L) (n = 30) (n = 6) (n = 63) (n = 28) (n = 35) (n= 15) Serum 16.3 ± 8.4 13.3 ± 7.5 13.4 ± 7.8 13.7 ± 9.5  14.0 ± 7.1 14.1± 5.2 folate (ng/mL) (n = 31) (n = 6) (n = 64) (n = 28) (n = 35) (n =15) Serum  338.1 ± 153.1 260.4 ± 66.4  350.8 ± 192.1 334.4 ± 176.6 320.4 ± 132.8 289.4 ± 88.7 vitamin B₁₂ (pg/mL) (n = 30) (n = 5) (n =59) (n = 28) (n = 35) (n = 13)p-values of 0.65 for tHcy, 0.18 for folate, and 0.69 for vitamin B₁₂(Kruskal-Wallis tests);p-values for 0.62 for tHcy, 0.25 for folate, and 0.79 for vitamin B₁₂(ANOVA models predicting log-transformed continuous variables withadjustment for sex)

1. A method for detecting an increased risk of cancer in a mammal, saidmethod comprising detecting the presence of a homozygous methioninesynthase reductase (MTRR) polymorphism in said mammal, wherein detectionof said polymorphism indicates said mammal has an increased risk ofdeveloping cancer.
 2. The method of claim 1, wherein said polymorphicMTRR is detected by analyzing nucleic acid from said mammal.
 3. Themethod of claim 2, wherein said nucleic acid is genomic deoxyribonucleicacid (DNA).
 4. The method of claim 2, wherein said nucleic acid iscomplementary DNA (cDNA).
 5. The method of claim 1, wherein saidpolymorphism is selected from the group consisting of: (a) a G insteadof an A at position 66 relative to the first nucleotide of the startcodon of MTRR, (b) a G instead of an A at position 110 relative to thefirst nucleotide of the start codon of MTRR, (c) a deletion of 4nucleotides starting from position 1675 (nucleotides 1675-1678) relativeto the first nucleotide of the start codon of MTRR, and (d) a deletionof 3 nucleotides starting from nucleotide 1726 (nucleotides 1726-1728)relative to the first nucleotide of the start codon of MTRR.
 6. Themethod of claim 2, wherein said polymorphic MTRR is detected by a methodcomprising: a) PCR-amplifying a segment of MTRR nucleic acid from saidfuture female parent, said embryo, or said fetus using primers MSG108S(SEQ ID NO: 49) and AD292 (SEQ ID NO: 50), and b) digesting the productof the PCR amplification reaction with the restriction enzyme Nde I,wherein a PCR product that is digested by Nde I indicates the presenceof said polymorphic MTRR.
 7. The method of claim 1, wherein saidpolymorphic MTRR is detected by analyzing MTRR polypeptide from saidmammal.
 8. The method of claim 1, said method further comprisingdetecting the presence of a polymorphic methylenetetrahydrofolatereductase (MTHFR) in said mammal, wherein detection of said polymorphicMTHFR indicates an increased risk of developing cancer.
 9. The method ofclaim 8, wherein said polymorphic MTHFR has a T instead of a C at anucleotide position equivalent to position 677 of SEQ ID NO:
 51. 10. Themethod of claim 8, wherein said polymorphic MTHFR is detected byanalyzing nucleic acid from said mammal.
 11. The method of claim 8,wherein said polymorphic MTHFR is detected by analyzing MTHFRpolypeptide from said mammal.
 12. The method of claim 1, wherein saidpolymorphic MTRR contains a methionine instead of an isoleucine at aminoacid position
 22. 13. The method of claim 1, wherein said cancer iscolon cancer.
 14. The method of claim 1, wherein said mammal is human.15. A method for detecting an increased risk of a folate/cobalaminmetabolic disorder in a mammal, said method comprising detecting thepresence of a homozygous MTRR polymorphism that indicates an increasedrisk of a folate/cobalamin metabolic disorder in said mammal, whereinsaid polymorphism comprises (a) a G instead of an A at position 66relative to the first nucleotide of the start codon of MTRR, (b) adeletion of 4 nucleotides starting from position 1675 (nucleotides1675-1678) relative to the first nucleotide of the start codon of MTRR,or (c) a deletion of 3 nucleotides starting from nucleotide 1726(nucleotides 1726-1728) relative to the first nucleotide of the startcodon of MTRR.
 16. The method of claim 15, wherein said folate/cobalaminmetabolic disorder is megablastic anemia, developmental delay,hyperhomocysteinuria, or hypomethionemia.
 17. The method of claim 15,wherein said mammal is human.
 18. The method of claim 15, furthercomprising measuring the level of cobalamin in said mammal.
 19. Themethod of claim 15, wherein said polymorphic MTRR is detected byanalyzing nucleic acid from said mammal.